7. child protection - Data.unhcr.org

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Table of Contents TABLES ............................................................................................................................. 6 LIST OF ABBREVIATIONS ................................................................................................. 17 EXECUTIVE SUMMARY .................................................................................................... 20 ACKNOWLEDGEMENTS ................................................................................................... 22 1. INTRODUCTION........................................................................................................... 23 2. SAMPLE AND METHODOLOGY ..................................................................................... 26 2.1. Management of the study ........................................................................................ 26 2.2. Ethical considerations .............................................................................................. 27 2.2.1. Ethical principles in research involving human beings .................................................... 27 2.2.2. Ethical risks ................................................................................................................... 27 2.2.3. Assent and informed consent ........................................................................................ 27 2.2.4. Privacy, confidentiality and data security ....................................................................... 28 2.2.5. Harms and benefits ....................................................................................................... 28 2.2.6. Risk management ......................................................................................................... 29 2.2.7. Child rights ................................................................................................................... 29 2.2.8. Gender perspectives ..................................................................................................... 29

2.3. Definition of sampling levels .................................................................................... 29 2.3.1. Domains ....................................................................................................................... 29 2.3.2. Mohafaza ..................................................................................................................... 30 2.3.3. Households ................................................................................................................... 31

2.4. Sample design .......................................................................................................... 31 2.4.1. Sample size ................................................................................................................... 31 2.4.2. Quantitative sample...................................................................................................... 32 2.4.2.1. Residents of Lebanon – sample ....................................................................................... 33 2.4.2.2. Registered Syrian refugees – sample............................................................................... 33 2.4.2.3. Syrian refugees living in ISs – sample .............................................................................. 33 2.4.2.4. Palestine refugees living in camps – sample ................................................................... 33 2.4.3. Qualitative sample ........................................................................................................ 34 2.4.3.1. Focus group discussions .................................................................................................. 34 2.4.3.2. Key informant interviews ................................................................................................ 34 2.4.4. Research instruments and data collection...................................................................... 35 2.4.4.1. Survey .............................................................................................................................. 35 2.4.4.2. Focus group discussions .................................................................................................. 35 2.4.4.3. Key informant interviews ................................................................................................ 35 2.4.5. Training ........................................................................................................................ 36 2.4.6. Data processing and analysis ......................................................................................... 36

ANNEX A. Sampling error and design effect ..................................................................... 37 3. HOUSEHOLD CHARACTERISTICS ................................................................................... 38 3.1. Characteristics of HHs: Overview .............................................................................. 38 3.2. Characteristics of HHs: Lebanese domain .................................................................. 43 3.3. Characteristics of HHs: Syrians registered with UNHCR domain ................................. 48

3 3.4. Characteristics of HHs: Syrians in ISs domain ............................................................ 52 3.5. Characteristics of HHs: Palestine refugees’ domain ................................................... 55 4. HEALTH ....................................................................................................................... 59 4.1. Situation analysis ..................................................................................................... 59 4.1.1. Health – sector response ............................................................................................... 59 4.1.2. Baseline indicators ........................................................................................................ 59

4.2. Qualitative findings overview ................................................................................... 63 4.2.1. Supply and demand of services ..................................................................................... 63 4.2.2. FGDs summary .............................................................................................................. 64

4.3. Baseline indicators: Health ....................................................................................... 66 4.3.1. All domains ................................................................................................................... 66 4.3.2. Lebanese domain .......................................................................................................... 68 4.3.3. Syrians registered with UNHCR domain ......................................................................... 74 4.3.4. Syrians in ISs domain..................................................................................................... 80 4.3.5. Palestine refugees domain ............................................................................................ 84

Bibliography ................................................................................................................... 88 5. WATER, SANITATION AND HYGIENCE (WASH) ............................................................. 90 5.1. Situation analysis ..................................................................................................... 90 5.1.1. WASH sector response .................................................................................................. 90 5.1.2. Baseline indicators ........................................................................................................ 90

5.2. Qualitative findings summary ................................................................................... 93 5.2.1. Supply and demand of services ..................................................................................... 93 5.2.2. FGDs summary .............................................................................................................. 95

5.3. Baseline indicators: WASH........................................................................................ 96 5.3.1. All domains ................................................................................................................... 96 5.3.2. Lebanese domain .......................................................................................................... 99 5.3.3. Syrians registered with UNHCR domain ....................................................................... 102 5.3.4. Syrians in ISs domain................................................................................................... 105 5.3.5. Palestine refugees domain .......................................................................................... 109

Bibliography ................................................................................................................. 112 6. EDUCATION .............................................................................................................. 114 6.1. Situation analysis ................................................................................................... 114 6.1.1 Education sector response............................................................................................ 114 6.1.2 Baseline indicators ....................................................................................................... 116

6.2. Qualitative findings overview ................................................................................. 117 6.2.1. Supply and demand of services ................................................................................... 117 6.2.2. FGDs summary ............................................................................................................ 119

6.3. Baseline indicators: Education ................................................................................ 121 6.3.1. All domains ................................................................................................................. 121 6.3.2. Lebanese domain ........................................................................................................ 124 6.3.3. Syrians registered with UNHCR domain ....................................................................... 130 6.3.4. Syrians in ISs domain................................................................................................... 137 6.3.5. Palestine refugees domain .......................................................................................... 141

4 Bibliography ................................................................................................................. 144 7. CHILD PROTECTION ................................................................................................... 146 7.1. Situation analysis ................................................................................................... 146 7.1.1. Child protection sector response ................................................................................. 146 7.1.2. Baseline indicators ...................................................................................................... 146


7.3. Baseline indicators: Child protection ...................................................................... 154 7.3.1. All domains ................................................................................................................. 154 7.3.2. Lebanese residents’ domain ........................................................................................ 159 7.3.3. Syrians registered with UNHCR domain ....................................................................... 168 7.3.4. Syrians in ISs domain................................................................................................... 177 7.3.5. Palestine refugees’ domain ......................................................................................... 184

Bibliography ................................................................................................................. 191 8. CHILD RIGHTS............................................................................................................ 193 8.1. Situation analysis ................................................................................................... 193 8.1.1. Child Rights policy response ........................................................................................ 193 8.1.2. Baseline indicators ...................................................................................................... 193


8.3. Baseline indicators: Child rights .............................................................................. 198 8.3.1. All domains ................................................................................................................. 198 8.3.2. Lebanese domain ........................................................................................................ 200 8.3.3. Syrians registered with UNHCR domain ....................................................................... 205 8.3.4. Syrians in ISs domain................................................................................................... 208 8.3.5. Palestine refugees domain .......................................................................................... 209

Bibliography ................................................................................................................. 211 9. DISABILITIES .............................................................................................................. 212 9.1. Situation analysis ................................................................................................... 213 9.1.1. Disabilities’ sector response ........................................................................................ 213 9.1.2. Baseline indicators ...................................................................................................... 215


9.3. Baseline indicators: Disabilities .............................................................................. 220 9.3.1. All domains ................................................................................................................. 220 9.3.2. Lebanese domain ........................................................................................................ 224 9.3.3. Registered Syrians domain .......................................................................................... 234 9.3.4. Syrians in ISs domain................................................................................................... 243 9.3.5. Palestine refugees domain .......................................................................................... 248

Bibliography ................................................................................................................. 253

5 10. C4D ......................................................................................................................... 254 10.1. Situation analysis ................................................................................................. 254 10.1.1. Preferred traditional media and type of programming ............................................... 254 10.1.2. Baseline indicators .................................................................................................... 255

10.2. Qualitative findings overview ............................................................................... 256 10.2.1. Supply and demand of services .......................................................................... 256 10.2.2. FGDs summary .......................................................................................................... 257

10.3. Baseline indicators: C4D ....................................................................................... 257 10.3.1. All domains ............................................................................................................... 257 10.3.2. Lebanese domain ...................................................................................................... 262 10.3.3. Syrians registered with UNHCR domain ......................................................................... 264 10.3.4. Syrian in ISs domain ...................................................................................................... 267 10.3.5. Palestine refugees’ domain ........................................................................................... 269

Bibliography ................................................................................................................. 272 11. BARRIERS AND RECOMMENDATIONS ...................................................................... 273 11.1. Analysis................................................................................................................ 273 11.2. Barriers and recommendations............................................................................. 275 11.2.1. Health....................................................................................................................... 275 11.2.2. WASH ....................................................................................................................... 277 11.2.3. Education.................................................................................................................. 279 11.2.4. Child protection ........................................................................................................ 279 11.2.5. Child rights................................................................................................................ 281 11.2.6. Disability................................................................................................................... 281 11.2.7. C4D........................................................................................................................... 282

Bibliography ................................................................................................................. 283 Annex: Selected indicators disaggregated by gender ..................................................... 284 Health .................................................................................................................................. 284 Water, sanitation and hygiene (WASH) ................................................................................. 284 Education ............................................................................................................................. 285 Child protection ................................................................................................................... 286 Child rights ........................................................................................................................... 287 Disabilities ........................................................................................................................... 288 C4D ...................................................................................................................................... 290

Appendix A. List of indicators Appendix B. Research questionnaire (English) Appendix C. Research questionnaire (Arabic) Appendix D. FGDs matrix

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TABLES 2. Sample and methodology

Table 2.1: Quantitative distribution of domains by mohafaza in Lebanon Table 2.2.: Distribution of FGDs based on the characteristics of participants and domain 3. Household characteristics Table 3.1: Gender of total respondents by domain and by gender Table 3.2: Gender of HH-heads by domain and by gender Table 3.3: Biological mother/father of children 0-17 years living in the HH by domain Table 3.4: Marital status of HH-members for all domains Table 3.5: Highest educational levels completed by total respondents Table 3.6: Housing arrangements by domain Table 3.7: HHs sharing their housing by domain Table 3.8: Rooms in the HH by domain excluding bathroom and kitchen Table 3.9: Type of disability of HH-members by domain Table 3.10: Availability of caregiver for HH-members with reported disability by domain Table 3.11: Lebanese HH-heads by gender Table 3.12: Total number of Lebanese HH-members by mohafaza Table 3.13: Age of all HH-members for the Lebanese domain Table 3.14: Marital status of HH-members in the Lebanese domain Table 3.15: Highest level of educational attainment of Lebanese respondents by mohafaza Table 3.16: Lebanese HH-members engaged in paid activity by age Table 3.17: Types of paid activity Lebanese HH-members are engaged in Table 3.18: Lebanese HH-members with disabilities who have received a disability card from the Ministry of Social Affairs Table 3.19: Subset percentage of Syrian HH-heads registered with UNHCR by gender Table 3.20: Number of Syrian HH-members registered with UNHCR by mohafaza Table 3.21: Age of all HH-members for the domain of Syrians registered with UNHCR Table 3.22: Marital status of HH-members in the domain of Syrians registered with UNHCR Table 3.23: Highest level of educational attainment of Syrian respondents registered with UNHCR by mohafaza Table 3.24: Syrian HH-members registered with UNHCR engaged in paid activity by age Table 3.25: Types of paid activity Syrian refugee HH-members registered with UNHCR are engaged in Table 3.26: Subset percentage of Syrian in ISs HH-heads by gender Table 3.27: Age of all HH-members for the Syrians in ISs domain Table 3.28: Marital status of HH-members in the Syrians in ISs domain by age Table 3.29: Marital status of HH-members in the Syrians in ISs domain by gender

7 Table 3.30: Highest educational level completed by Syrian respondents in ISs by gender Table 3.31: Syrians in ISs HH-members engaged in paid activity by age Table 3.32: Subset percentage of Palestine refugee HH-heads by gender Table 3.33: Age of all HH-members for the Palestine refugee domain Table 3.34: Marital status of HH-members in the Palestine refugees’ domain by age Table 3.35: Marital status of HH-members for Palestine refugees’ domain by gender Table 3.36: Highest educational level completed by Palestine refugee respondents by gender Table 3.37: Palestine refugee HH-members engaged in paid activity by age 4. Health Table 4.1: WHO and UNICEF, Estimates of Immunization Coverage in Lebanon (2016) Table 4.2: Health FGDs matrix Table 4.3: Overview of health indicator on vaccination by domain, gender and in total Table 4.4: Overview of health indicators on antenatal care and child delivery Table 4.5: Results of total respondents when asked who paid for the mother’s delivery of the last child in the household Table 4.6: Overview of health indicators on breastfeeding by domain, gender and in total Table 4.7: Results of Lebanese caretakers being asked how many vaccination sessions children of the age of one year need to have completed Table 4.8: Results by gender of Lebanese respondents being asked where they usually go to receive a vaccination for their child Table 4.9: Primary reason cited by Lebanese respondents when asked why they did not go to a PHC, dispensary or MOSA/SDC clinic to vaccinate their child Table 4.10: Lebanese respondents’ time needed to reach the nearest health clinic by mohafaza Table 4.11: Lebanese mothers’ responses on frequency of ANC visits during their most recent completed pregnancy Table 4.12: By mohafaza: type of medical institution accessed by Lebanese female respondents with at least one child who visited antenatal care for the last child delivered Table 4.13: Options cited by Lebanese respondents regarding who paid for the mother’s most recent delivery Table 4.14: Reasons cited by Lebanese respondents for believing in exclusive breastfeeding Table 4.15: Lebanese respondents who state their attitudes towards the duration of breastfeeding Table 4.16: Reasons cited by Lebanese for why mothers do not breastfeed or stop breastfeeding Table 4.17: Results of Syrian caretakers registered with UNHCR being asked how many vaccination sessions children of the age of one year need to have completed Table 4.18: Results by gender of Syrian respondents registered with UNHCR asked where they usually go to receive a vaccination for their child Table 4.19: Primary reason cited by Syrian respondents registered with UNHCR when asked why they did not go to a PHC, dispensary or MOSA/SDC clinic for vaccination Table 4.20: Time needed by Syrians registered with UNHCR to reach the nearest health clinic by mohafaza

8 Table 4.21: Responses of Syrian mothers registered with UNHCR on frequency of ANC visits during their most recent completed pregnancy Table 4.22: By mohafaza: type of medical institution accessed by Syrian female respondents registered with UNHCR with at least one child who visited antenatal care for the last child delivered Table 4.23: Options cited by Syrian respondents registered with UNHCR on who paid for the mother’s most recent delivery Table 4.24: Reasons cited by Syrian respondents registered with UNHCR for believing in exclusive breastfeeding Table 4.25: Syrian respondents registered with UNHCR who state their attitudes towards the duration of breastfeeding Table 4.26: Reasons cited by Syrian respondents registered with UNHCR for why mothers do not breastfeed or stop breastfeeding Table 4.27: Results of Syrian caretakers in ISs being asked how many vaccination sessions children of the age of one year need to have completed Table 4.28: Results by gender of Syrian respondents in ISs when asked where they usually go to receive a vaccination for their child Table 4.29: Primary reason cited by Syrian respondents in ISs when asked why they did not go to a PHC, dispensary or MOSA/SDC clinic Table 4.30: Syrian mothers in ISs’ responses on frequency of ANC visits during their most recent completed pregnancy Table 4.31: Options cited by Syrian respondents in ISs on who paid for the mother’s most recent delivery Table 4.32: Reasons cited by Syrian respondents in ISs for believing in exclusive breastfeeding Table 4.33: Syrian respondents in ISs stating their attitude towards the duration of breastfeeding Table 4.34: Reasons cited by Syrian respondents in ISs for why mothers do not breastfeed or stop breastfeeding Table 4.35: Results of Palestine refugee caretakers being asked how many vaccination sessions children of the age of one year need to have completed Table 4.36: Results by gender of Palestine refugee respondents asked where they usually go to receive a vaccination for their child Table 4.37: Palestine refugee mothers’ responses on frequency of ANC visits during their most recent completed pregnancy Table 4.38: Reasons cited by Palestine refugee respondents for believing in exclusive breastfeeding Table 4.39: Lebanese respondents who state their attitude towards the duration of breastfeeding Table 4.40: Reasons cited by Palestine refugee for why mothers do not breastfeed or stop breastfeeding 5. Water, sanitation and hygiene (WASH) Table 5.1: Access to hygiene items in selected districts in Lebanon Table 5.2: Indicator targets as per LCRP 2017-2020 Table 5.3: Water supply sources in Lebanon Table 5.4: WASH FGDs matrix Table 5.5: Main source of drinking water as cited by total domains Table 5.6: Most important times to wash hands during the day as cited by total domains Table 5.7: Most important ways to prevent disease transmission as cited by total domains

9 Table 5.8: The two most common types of households’ solid wastes for total domains Table 5.9: Ways in which households usually dispose of solid waste for total domains Table 5.10: Total households who share their toilet or latrine with other households or individuals Table 5.11: Main source of drinking water for households of Lebanese residents Table 5.12: Lebanese respondents citing the most important times to wash hands during the day Table 5.13: Lebanese respondents citing the most important ways to prevent disease transmission amongst people Table 5.14: The two most common types of solid wastes in Lebanese households Table 5.15: Disposal of solid waste in Lebanese households Table 5.16: Categories in which solid waste is sorted out in for Lebanese households who state to sort their waste at the source Table 5.17: Main source of drinking water for households of Syrians registered with UNHCR Table 5.18: The most important times to wash hands during the day as cited by Syrian refugees registered with UNHCR Table 5.19: Syrian respondents registered with UNHCR citing the most important ways to prevent disease transmission amongst people Table 5.20: The two most common types of solid wastes in households of Syrian refugees registered with UNHCR Table 5.21: Disposal of solid waste in households of Syrian refugees registered with UNHCR Table 5.22: Main source of drinking water for households of Syrians in ISs Table 5.23: The most important times to wash hands during the day as cited by Syrians living in ISs Table 5.24: Syrian respondents living in ISs citing the most important ways to prevent disease transmission amongst people Table 5.25: The two most common types of solid waste in households of Syrians living in ISs Table 5.26: Disposal of solid waste in households of Syrians living in ISs Table 5.27: Syrian households in ISs who share their toilet or latrine with other families or individuals Table 5.28: Hygienic condition of toilet or latrine as reported by Syrians living in ISs who share their bathroom with other families or individuals Table 5.29: Main source of drinking water for households of Palestine refugees Table 5.30: The most important times to wash hands during the day as cited by Palestine refugees Table 5.31: Palestine refugees citing the most important ways to prevent disease transmission amongst people Table 5.32: The two most common types of solid wastes in households of Palestine refugees Table 5.33: Disposal of solid waste in households of Palestine refugees Table 5.34: Categories into which solid waste is sorted in Palestine refugee households that state that they sort their waste at the source 6. Education Table 6.1: % of out-of-school children per governorate Table 6.2: NFE pathways in Lebanon Table 6.3: Education FGDs matrix Table 6.4: Education indicators on caregivers’ knowledge on formal and non-formal education by domains, gender and in total Table 6.5: Education indicators on attitudes towards girls’ participation in education by domains and in total Table 6.6: Education indicators on attitudes towards quality of services by domains, gender and in total Table 6.7: Lebanese respondents who know how to enrol children in formal schools Table 6.8: Lebanese respondents’ attitudes towards girls participation in education by mohafaza and in total

10 Table 6.9: Lebanese respondents’ attitudes on the age girls at which should leave school Table 6.10: Lebanese caregivers who would send their children to Lebanese public schools by mohafaza Table 6.11: Circumstances under which Lebanese caregivers would send their children to a public school Table 6.12: Syrian respondents registered with UNHCR who know how to enrol children in formal schools Table 6.13: Syrian caregivers registered with UNHCR by mohafaza who believe that they can enrol their child in a Lebanese public school without any documents Table 6.14: Syrian respondents registered with UNHCR’s attitudes towards girls staying in school until graduation by region Table 6.15: Syrian respondents registered with UNHCR’s attitudes on the age at which girls should leave school Table 6.16: Syrian caregivers registered with UNHCR who would send their children to Lebanese public schools by mohafaza Table 6.17: Circumstances under which Syrian caregivers registered with UNHCR would send their children to a Lebanese public school Table 6.18: Syrian caregivers registered with UNHCR who believe that can enrol their children in a Lebanese public school without any documents Table 6.19: Syrian respondents in ISs’ attitudes on the age at which girls should leave school Table 6.20: Syrian caregivers in ISs who would send their children to Lebanese public schools Table 6.21: Circumstances under which Syrian caregivers in ISs would send their children to Lebanese public school Table 6.22: Palestine refugee respondents’ attitudes on the age at which girls should leave school Table 6.23: Palestine refugee caregivers who would send their children to UNRWA schools Table 6.24: Circumstances under which Palestine refugee caregivers would send their children to UNRWA school Table 6.25: Palestine refugee children’s attendance of NFE programmes 7. Child protection Table 7.1: Type of labour by age group Table 7.2: CP FGDs matrix Table 7.3: Overview of CP indicator on knowledge of harmful consequences of child marriage by domain, gender and in total Table 7.4: Negative consequences of child marriage as cited by total respondents Table 7.5: Overview of CP indicator on knowledge of reporting CP and GBV violations by domain, gender and in total Table 7.6: Overview of CP indicator on positive attitudes towards seeking CP and GBV services through MOSA and NGOs by domain, gender and in total Table 7.7: Overview of CP indicator on attitudes towards participation of minors in armed violence by domain, gender and in total Table 7.8: Overview of CP indicator on knowledge on child labour by domain, gender and in total Table 7.9: Types of work total respondents believe children above the minimum working age are legally allowed to work in Table 7.10: Overview of CP indicator on knowledge on positive discipline by domain, gender and in total Table 7.11: Overview of CP indicator on attitudes towards positive discipline by domain, gender and in total

11 Table 7.12: Responses on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue) in total Table 7.13: Attitudes towards protection risks for boys by Lebanese respondents Table 7.14: Attitudes towards protection risks for girls by Lebanese respondents Table 7.15: Perceived age at which girls usually get married cited by Lebanese respondents by mohafaza Table 7.16: Reasons cited by Lebanese respondents who believe that child marriage has or might have negative consequences Table 7.17: Lebanese respondents’ attitudes on whom a woman would inform regarding a protection issue for herself by gender Table 7.18: Formal and informal actors Lebanese respondents would inform about a protection issue for a child under 18 years by gender Table 7.19: Lebanese respondents who believe protection services provided to children and women through MOSA and NGOs are useful by gender Table 7.20: Lebanese respondents who believe protection services provided to children and women through MOSA and NGOs are useful by mohafaza Table 7.21: Types of work Lebanese respondents believe children above the minimum working age are legally allowed to work in by mohafaza Table 7.22: Lebanese respondents’ attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue) Table 7.23: Attitudes towards protection risks for boys by Syrian respondents registered with UNHCR Table 7.24: Attitudes towards protection risks for boys by Syrian respondents registered with UNHCR Table 7.25: Perceived age at which girls usually get married cited by Syrian respondents registered with UNHCR by mohafaza Table 7.26: Reasons cited by Syrian respondents registered with UNHCR who believe that child marriage has or might have negative consequences Table 7.27: Syrians respondents registered with UNHCR’s attitudes on whom a woman would inform regarding a protection issue for herself by gender Table 7.28: Formal and informal actors Syrians respondents registered with UNHCR would inform about a protection issue for a child under 18 years by gender Table 7.29: Syrian respondents registered with UNHCR who believe protection services provided to children and women through MOSA and NGOs are useful by gender Table 7.30: Syrian respondents registered with UNHCR who believe protection services provided to children and women through MOSA and NGOs are useful by mohafaza Table 7.31: Types of work Syrian respondents registered with UNHCR believe children above the minimum working age are legally allowed to work in by mohafaza Table 7.32: Syrian respondents registered with UNHCR’s attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue) Table 7.33: Attitudes towards protection risks for boys by Syrian respondents in ISs Table 7.34: Attitudes towards protection risks for girls by Syrian respondents in ISs Table 7.35: Perceived age at which girls usually get married cited by Syrian respondents in ISs Table 7.36: Reasons cited by Syrian respondents in ISs who believe that child marriage has or might have negative consequences Table 7.37: Syrian respondents in ISs attitudes on whom a woman would inform regarding a protection issue for herself by gender

12 Table 7.38: Formal and informal actors Syrians respondents in ISs would inform about a protection issue for a child under 18 years by gender Table 7.39: Syrian respondents in ISs who believe protection services provided to children and women through MOSA and NGOs are useful by gender Table 7.40: Types of work Syrian respondents in ISs believe children above the minimum working age are legally allowed to work in Table 7.41: Syrian respondents in ISs’ attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue) Table 7.42: Attitudes towards protection risks for boys by Palestine refugee respondents Table 7.43: Attitudes towards protection risks for girls by Palestine refugee respondents Table 7.44: Perceived age at which girls usually get married cited by Palestine refugee respondents Table 7.45: Reasons cited by Palestine refugee respondents who believe that child marriage has or might have negative consequences Table 7.46: Palestine refugee respondents’ attitudes on whom a woman would inform regarding a protection issue for herself by gender Table 7.47: Formal and informal actors Palestine refugee respondents would inform about a protection issue for a child under 18 years by gender Table 7.48: Palestine refugee respondents who believe protection services provided to children and women through NGOs are useful by gender Table 7.49: Types of work Palestine refugee respondents believe children above the minimum working age are legally allowed to work in Table 7.50: Palestine refugee respondents’ attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue) 8. Child rights Table 8.1: Child rights FGDs matrix Table 8.2: Overview of child rights indicator by domain, gender and in total: percentage of respondents who are aware of child rights Table 8.3: Total respondents’ results when asked what kind of rights they think ‘child rights’ refer to Table 8.4: Overview of child rights indicator of duty bearers who are aware of their role in safeguarding child rights’ results by domain and total Table 8.5: Overview of child rights indicator by domain and total of duty bearers who are aware of their role in safeguarding child rights Table 8.6: Overview of child rights indicator by domain and total of duty bearers who are aware of their role in safeguarding child rights Table 8.7: Overview of child rights indicator of Lebanese households who are aware of the NPTP by gender and mohafaza Table 8.8: Answers given by Lebanese respondents when asked what ‘child rights’ refers to Table 8.9: Lebanese respondents who feel that it is their duty to protect child rights, whether they have children or not. Table 8.10: Lebanese respondents, by mohafaza, who are aware of the NPTP Table 8.11: Lebanese respondents by gender who believe that the NPTP effectively targets and serves the most vulnerable households

13 Table 8.12: Lebanese respondents, by age, who believe that the NPTP effectively targets and serves the most vulnerable households Table 8.13: Answers given by Syrian respondents registered with UNHCR when asked what ‘child rights’ refers to Table 8.14: Syrian respondents registered with UNHCR who think that it is their duty to protect child rights, whether they have children or not Table 8.15: Answers given by Syrian respondents in ISs when asked what ‘child rights’ refers to Table 8.16: Syrian respondents in ISs who think that it is their duty to protect child rights, whether they have children or not Table 8.17: Answers given by Palestine refugee respondents when asked what child rights refers to Table 8.18: Palestine refugee respondents who feel that it is their duty to protect child rights, whether they have children or not 9. Disabilities Table 9.1: Distribution of MOSA disability card holders by age Table 9.2: Distribution of MOSA disability card holders by gender Table 9.3: Distribution of PDC holders by mohafaza of Residence Table 9.3: Distribution of MOSA disability card holders by type of disability Table 9.5: Disabilities FGDs matrix Table 9.6: Overview of disabilities indicators results by domain, gender and in total Table 9.7: Respondents who believe children with physical disabilities should go to regular preschools and schools by domain and in total Table 9.8: Respondents who believe that young people with disabilities should work by domain and in total Table 9.9: Respondents who believe children with disabilities should be integrated into society by domain and in total Table 9.10: Respondents who believe that children with disabilities should participate in community life by domain and in total Table 9.11: Respondents who find it acceptable if families of children with disabilities place them in residential institutions by domain and in total Table 9.12: Lebanese respondents who believe that children with physical disabilities should go to regular school or preschool with other children by mohafaza Table 9.13: Reasons cited by Lebanese respondents who believe that children with physical disabilities should not go to regular school or preschool with other children Table 9.14: Lebanese respondents who believe that children with intellectual disabilities should go to regular school and preschool with other children by mohafaza Table 9.15: Reasons cited by Lebanese respondents who believe that children with intellectual disabilities should not go to regular school and preschool with other children Table 9.16: Lebanese respondents who believe young people with physical disabilities should work by mohafaza Table 9.17: Lebanese respondents who believe young people with intellectual disabilities should work by mohafaza Table 9.18: Lebanese respondents who believe children with physical disabilities be fully integrated in society by mohafaza

14 Table 9.19: Lebanese respondents who believe children with intellectual disabilities be fully integrated in society by mohafaza Table 9.20: Lebanese respondents who believe children with physical disabilities should participate in community activities by mohafaza Table 9.21: Lebanese respondents who believe children with intellectual disabilities should participate in community activities by mohafaza Table 9.22: Lebanese respondents who believe it is acceptable to place children with physical disabilities in residential institutions by mohafaza Table 9.23: Lebanese respondents who believe it is acceptable to place children with intellectual disabilities in residential institutions by mohafaza Table 9.24: Syrian respondents registered with UNHCR who believe that children with physical disabilities should go to regular school or preschool with other children by mohafaza Table 9.25: Reasons cited by Syrian respondents registered with UNHCR who believe that children with physical disabilities should not go to regular school or preschool with other children Table 9.26: Syrian respondents registered with UNHCR who believe that children with intellectual disabilities should go to regular school or preschool with other children by mohafaza Table 9.27: Reasons cited by Syrian respondents registered with UNHCR who believe that children with intellectual disabilities should not go to regular school or preschool with other children Table 9.28: Syrian respondents registered with UNHCR who believe that young people with physical disabilities should work by mohafaza Table 9.29: Syrian respondents registered with UNHCR who believe that young people with intellectual disabilities should work by mohafaza Table 9.30: Syrian respondents registered with UNHCR who believe children with physical disabilities should be fully integrated in society by mohafaza Table 9.31: Syrian respondents registered with UNHCR who believe children with intellectual disabilities should be fully integrated in society by mohafaza Table 9.32: Syrian respondents registered with UNHCR who believe children with physical disabilities should participate in community life by mohafaza Table 9.33: Syrian respondents registered with UNHCR who believe children with intellectual disabilities should participate in community life by mohafaza Table 9.34: Registered Syrian respondents with UNHCR who find it acceptable to place children with physical disabilities in residential institutions by mohafaza Table 9.35: Syrian respondents registered with UNHCR who find it acceptable to place children with intellectual disabilities in residential institutions by mohafaza Table 9.36: Syrian respondents in ISs who believe that children with physical disabilities should not attend regular school or preschool Table 9.37: Syrian respondents in ISs who believe that children with intellectual disabilities should not attend regular school or preschool Table 9.38: Syrian respondents in ISs who believe young people with physical disabilities should work Table 9.39: Syrian respondents in ISs who believe young people with intellectual disabilities should work Table 9.40: Syrian respondents in ISs who think children with physical disabilities should be fully integrated in society Table 9.41: Syrian respondents in ISs who think children with intellectual disabilities should be fully integrated in society Table 9.42: Syrian respondents in ISs who believe children with physical disabilities should participate in community life Table 9.43: Syrian respondents in ISs who believe children with intellectual disabilities should participate in community life Table 9.44: Syrian respondents in ISs who believe it is acceptable to place children with physical disabilities in residential institutions

15 Table 9.45: Syrian respondents in ISs who believe it is acceptable to place children with intellectual disabilities in residential institutions Table 9.46: Palestine refugee respondents who believe that children with physical disabilities should not attend regular school or preschool Table 9.47: Palestine refugee respondents who believe that children with intellectual disabilities should not attend regular school or preschool Table 9.48: Palestine refugee respondents who believe young people with physical disabilities should work Table 9.49: Palestine refugee respondents who believe young people with physical disabilities should work Table 9.50: Palestine refugees who believe that children with physical disabilities should be fully integrated in society Table 9.51: Palestine refugees who believe that children with intellectual disabilities should be fully integrated in society Table 9.52: Palestine refugees who believe that children with physical disabilities should participate in community life Table 9.53: Palestine refugees who believe that children with intellectual disabilities should participate in community life Table 9.54: Palestine refugees who find it acceptable to place children with physical disabilities in residential institutions Table 9.55: Palestine refugees who find it acceptable to place children with intellectual disabilities in residential institutions 10. C4D Table 10.1: Exposure to traditional media among women aged 15-49 Table 10.2: Exposure to Internet and social media among women aged 15-49 Table 10.3: Lebanese TV networks audience shares (2016) Table 10.4: Preferred type of TV programming for all domains by gender Table 10.5: Total respondents’ preferred time of day to watch TV Table 10.6.: Overview of C4D indicator on access and use of the Internet by domain, gender and in total Table 10.7: Responses on use of Internet by total respondents by domain Table 10.8: Overview of C4D indicator on access and use of social media by domain, gender and in total Table 10.9: Total respondents’ access to social media (Facebook, Twitter and other apps) by domain Table 10.10: What total respondents use social media for the most by domain Table 10.11: Total respondents preferred way to receive information about available UNICEF services Table 10.12: Lebanese respondents’ preferred type of TV programming Table 10.13: Lebanese respondents’ preferred time to watch TV during the day Table 10.14: Lebanese respondents’ frequency of accessing internet Table 10.15: Lebanese respondents’ preferred way of receiving information about available UNICEF services Table 10.16: Preferred type of TV programming of Syrian respondents registered with UNHCR Table 10.17: Preferred time to watch TV during the day of Syrians registered with UNHCR Table 10.18: Frequency of accessing internet of Syrians registered with UNHCR Table 10.19: Syrians registered with UNHCR’s preferred way of receiving information about available UNICEF services Table 10.20: Syrians in ISs’ preferred type of TV programming Table 10.21: Syrians in ISs preferred time to watch TV during the day

16 Table 10.22: Syrians in ISs frequency of accessing internet Table 10.23: Syrians in ISs preferred way of receiving information about available UNICEF services Table 10.24: Palestine refugees’ preferred type of TV programming Table 10.25: Palestine refugees’ preferred time to watch TV during the day Table 10.26: Palestine refugees’ frequency of accessing internet Table 10.27: Palestine refugees’ preferred way of receiving information about available UNICEF services 11. Barriers and recommendations Table 11.1: Internal and external stakeholders in healthcare (internal stakeholders: MOPH, MOSA and medical professionals; external stakeholders: households, children and caregivers). Table 11.2: Health indicators by domain and gender Table 11.3: Drinking water indicator by domain and gender Table 11.4: Education indicators by domain and gender Table 11.5: Child protection indicators by domain and gender Table 11.6: Child rights indicators by domain and gender Table 11.7: Disabilities indicators by domain and gender Table 11.8: C4D indicators by domain and gender Table 11.9: C4D indicators by domain and gender Table 11.10: C4D indicators by domain and gender

17

LIST OF ABBREVIATIONS ACSII

American Standard Code for Information Interchange, a character encoding standard

ALP

Accelerated Learning Programme

ANC

Antenatal care

BLN

Basic Literacy and Numeracy

BML

Beirut and Mount Lebanon

BP

Brevet professionnel (Professional Brevet)

BT

Baccalaureat technique (Technical baccalaureate)

C4D

Communication for Development; that is, various types of strategic communication that enable positive social change

CB-ECE

Community-based early childhood education

CP

Child protection

CPD

Country Programme Document

CRC

Child Rights Convention

DK

Do not know

ECE

Early childhood education

FGD

Focus group discussion, a social scientific research method

GBV

Gender-based violence

HCC

Higher Council for Childhood

IS

Informal settlement

KAP

Knowledge, Attitude and Practice

KII

Key informant interview

LCRP

Lebanon Crisis Response Plan

LT

Licence Technique (technical license)

18 MEHE

Ministry of Education and Higher Education

MENA

Middle East and North Africa

MEW

Ministry of Energy and Water

MOSA

Ministry of Social Affairs

MOPH

Ministry of Public Health

NFE

Non-formal education

NGO

Non-governmental organisation

NPTP

National poverty-targeting plan

NVivo

Qualitative data analysis software

OCHA

United Nations Office for the Coordination of Humanitarian Affairs

Orecomm

International centre at Malmö University, Sweden, for research in the field of C4D

PHC

Public health centre

PSS

Psycho-social support

PSU

Primary sampling unit

PRL

Palestine refugees from Lebanon

PRS

Palestine refugees from Syria

PWD

Person with disability

RACE

Reaching All Children with Education programme

RACE II

Second phase of Lebanon’s Reaching All Children with Education programme

REACH

Joint initiative of two NGOs, IMPACT and ACTED, and the United Nations Operational Satellite Applications Programme (UNOSAT)

SDC

Social Development Centre

SMO

Statistics and Monitoring Officer

SOP

Standard Operation Procedures

SPSS

Statistical Package for the Social Sciences, a software package for statistical analysis

TS

Technicien Supérieur (senior technician)

TVET

Technical and Vocational Education and Training

UN

United Nations

UNFPA

United National Population Fund

19 UNHCR

United Nations Refugee Agency

UNICEF

United Nations International Children's Emergency Fund

UNRWA

United Nations Relief and Works Agency for Palestine Refugees in the Near East

WASH

Water, sanitation and hygiene

WE network

Water establishment network

WHO

World Health Organization

WFP

World Food Programme

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EXECUTIVE SUMMARY This is the report for the Cross-sectoral formative research – Knowledge, attitude and practice study, hereafter KAP Study, which was conducted by researchers from Malmö University, Sweden, on behalf of the country office of UNICEF Lebanon. The purpose of the KAP Study is, -

To establish a baseline for UNICEF Lebanon’s Country Programme Document for the period 2017 to 2020 To recommend C4D interventions that are successful in removing barriers to the adoption of positive practices with regard to education, child survival, child protection, child rights and social inclusion

The background for the KAP Study is the impact of the Syrian crisis. Lebanon has received more international refugees per capita than any other country in the world. This has created an immense stress on Lebanon’s institutional capacities. Over one million children in Lebanon are directly affected by the crisis. They are in need of basic services like education, health care, clean water, as well as of protection and inclusion. The empirical scope of the KAP Study has been -

To include Lebanese residents, Syrian refugees registered with UNHCR, Syrian refugees living in informal settlements and Palestine refugees living in Lebanon’s designated camps To cover each mohafaza (governorate) in Lebanon To include female and male respondents of all age groups To provide results on indicators for each of UNICEF Lebanon’s programme areas

The data for the KAP Study were collected using three methods, one quantitative and two qualitative: -

Questionnaire-based interviews with 7,000 households 48 focus group discussions 42 key informant interviews

From the collected data on the various indicators could be drawn conclusions about knowledge gaps and barriers to positive attitudes and practice, both among external stakeholders (caregivers and children) and internal stakeholders (providers of public services, including UNICEF and partners): External stakeholders -

Attitudinal challenges and knowledge gaps with regard to gender differences Knowledge gaps on vaccinations, breastfeeding and menstruation Attitudinal challenges because of intensifying and spreading conservative norms, for example with regard to child marriage, family planning and forced pregnancies Gap between favourable attitudes towards positive discipline and persisting practice of negative discipline

21 -

-

Lack of knowledge: children and caregivers do not know that child rights, in addition to a right to basic services, also include the right of expression, participation in decision-making and social inclusion Alarming knowledge gap with regard to disabilities

Internal stakeholders -

Capacity gaps in the field of medical ethics Capacity gaps in the delivery of clean water and the treatment of wastewater Insufficient capacities in the field of education Inadequate practices in the field of child protection, especially insufficient protection against violence Insufficient capacities to build trust, so that women are ready to report incidents of GBV and CP violations to formal authorities Insufficient capacity to professionally identify disabilities Insufficient integration of disability perspectives with other programmes Need for more participatory C4D initiatives

22

ACKNOWLEDGEMENTS The KAP Study was conducted by Malmö University, Sweden, for UNICEF Lebanon. The study team would like to extend its gratitude to the ministries, agencies, organisations, individuals and communities who shared their experience and insights and made this research possible. We would specifically like to thank Ibrahim Elsheikh, Rodolphe Ghoussoub and Julianne Birungi for their advice and assistance in planning, designing and executing the KAP Study. Thanks go also to UNICEF’s focal points for the KAP study in programme sections, including but not limited to Meri Poghosyan, Christina Bock, Rouham Yamout, Diala Ktaiche, Nabil Rizk, Bochra El Moghrabi, Marta Passerini, Abir Abi Khalil, Sarah Bou Ajram, Matthew Swift and Jihane Latrous. We want to acknowledge the support from UNICEF zonal office staff, who provided in-depth insight into challenges and opportunities ‘on the ground’ and who greatly facilitated qualitative data collection. Our thanks go to Mireille Abdallah, Hania Saket, Georges Fares, Sabeen Abdulsater, Nadeen Al Hebshi, Antoine Ghazaly, Safa Maita, Farah Hammoud, Zeina Abou Zeid, Farah Mazloum, Iman Al Khatib and Abbas Safieddine and all those who are not named here, but who lent support to this study. We would also like to express our gratitude to heads of UNICEF zonal offices and of programme sections, including, but not limited to, Muhammad Rafiq, Damascus Macheri, Prem Bahadur Chand, Colette Najm, Berta Travieso, Johanna Eriksson Takyo, and Marta Petagna. We would also like to thank UNICEF partners who supported FGDs in different mohafazat, including Caritas Lebanon, Terre des Hommes Italy, Save the Children and KAFA. We further extend our gratitude to KAP Study focal points and respondents within Lebanese government ministries, who provided expert advice and numerous insights into challenges and opportunities for action, including, but not limited to, Hiba Assaf, Suheir Ghaly, Wafaa Kanaan, Pamela Mansour, Marie Haj, Wadih Tawaneh, Dania Sharaf, as well as the Director Generals of the Ministry of Social Affairs, Ministry of Public Health, Ministry of Education and Higher Education and Ministry of Energy and Water. Last but not least, we would like to thank the extended study team, including Rabih Haber, Dolly Farhat, Samia Jouzi, Elie Joukhadar and Khouloud Mardini. The KAP Study was led and the final report authored by Ronald Stade ([email protected]), Lana Khattab ([email protected]) and Erik van Ommering ([email protected]). Copyright for the cover picture: Lana Khattab.

23

1. INTRODUCTION This is the report for the Cross-sectoral formative research – Knowledge, attitude and practice study, hereafter KAP Study. The KAP Study was conducted in 2017 by researchers at Malmö University, Sweden, on behalf of the country office of UNICEF Lebanon.

1.1. Background of the study Lebanon has received more international refugees per capita than any other country in the world. Most of the refugees fled the Syrian crisis that began in 2011. Lebanon’s pre-crisis population has been estimated at 4.2 million. The number of registered Syrian refugees is in excess of 1 million. In addition, Lebanon hosts hundreds of thousands of non-registered refugees from Syria, of whom many stay in informal settlements (ISs). Furthermore, close to half a million Palestine refugees reside in Lebanon, some 50% of whom still live in Lebanon’s 12 designated Palestine refugee camps. According to UNICEF Lebanon’s estimations, approximately 630,000 Syrian refugee children, 470,000 Lebanese children, and 120,000 Palestine refugee children are affected by the Syrian crisis. They are in need of basic services like education, health care, water and sanitation, protection and inclusion. An immense burden has been placed upon the delivery of these services, in particular because poor host communities and refugees often rely on the same access points and resources for basic services.

In total, 1,220,000 children are in need of basic services in Lebanon. The crisis has increased the risk of violence, exclusion and exploitation for children. Without protection and basic services, an entire generation of children could be lost. UNICEF Lebanon addresses these issues by working in five priority areas for which there are four programmes: education, child survival, which consists of health and WASH (water, sanitation and hygiene), child protection, and youth.

In addition, UNICEF has a dedicated section for Palestine refugees in Lebanon who live in and outside twelve designated camps.

24 Another programme is social inclusion, The objective is to ensure that the supply in these which cuts across the five other areas meets the factual demand and that the demand programmes. In this programme, there is corresponds to actual needs. a strong C4D (Communication for Development) component with the mission to develop and conduct interventions for behaviour and social change. Knowledge and attitudes shape practice, which is why interventions for behaviour and social change target areas like awareness, motivation, norms etc. In the case of Lebanon, particular attention is paid to barriers to the kind of behaviour that would ensure children’s right to education, health, WASH, protection and inclusion.

1.2. Purpose and scope of the study The purpose of the KAP Study is twofold: (1) To establish a baseline for UNICEF Lebanon’s Country Programme Document for the period 2017 to 2020 (2) To recommend C4D interventions that are successful in removing barriers to the adoption of positive practices with regard to education, child survival, child protection, child rights and social inclusion The main purpose of the KAP Study has been to obtain current estimates of key indicators measuring knowledge, attitudes and practices for each of UNICEF Lebanon’s priority areas, except for youth, as UNICEF will undertake a separate study dedicated to youth. The KAP Study encompasses four of Lebanon’s population groups or domains: • • • •

Lebanese citizens Syrian refugees registered with UNCHR and included in its database1 Syrian refugees living in ISs Palestine refugees living in camps

Data were collected in each of Lebanon’s (at the time of the study) eight mohafazat (governorates; singular form: mohafaza). The volume of data collection was as follows: • • •

7,000 household interviews using questionnaires 48 focus group discussions 42 key informant interviews

The KAP Study ran from 2 January 2017 to 12 October 2017.

1

In order to design the sample for registered Syrian refugees and to reach them for the KAP Study survey, a data sharing agreement was developed between UNHCR, UNICEF and Malmö University, which states the lawful and confidential sharing of names and phone numbers of registered Syrian refugees in Lebanon. UNHCR conducts the registration of refugees and asylum-seekers in the country, subject to the availability of resources and to the Office’s operational needs. UNHCR’s Syrian refugee’s database is essential for preparing population samples and for contacting the selected individuals for undertaking assessments.

25 1.4. Report structure This report is subdivided into eleven chapters. The first three chapters introduce the report, present the method of sampling and methodology used in the KAP Study, as well as the characteristics of the surveyed households. Each of the following seven chapters is devoted to one of UNICEF Lebanon’s programme areas and contains data and findings for predefined indicators. The programmatic chapters begin with a situation analysis that outlines the knowledge on key indicators prior to the KAP Study. Thereafter follows a summary of the supply-and-demand aspect of services and a precis of the qualitative data. The rest of the chapters is devoted to a presentation of quantitative data and their analysis. At the end of each chapter is an annex and, in some cases, a bibliography.

Structure of chapters 4-10 •

Programmatic area as chapter title - Situation analysis - Qualitative findings overview ▪ Supply and demand of services ▪ FGDs summary - Quantitative findings – baseline indicators ▪ All domains ▪ Lebanese residents domain ▪ Syrians registered with UNHCR domain ▪ Syrians in ISs domain ▪ Palestine refugees domain - Bibliography - Annex

The last chapter contains an overarching analysis and a list of barriers. It is concluded with recommendations for further action. A number of appendices are attached to the report (see the Table of Contents).

26

2. SAMPLE AND METHODOLOGY The methodology for the KAP Study was designed to provide estimates for a number of key indicators on duty bearers’ and children’s knowledge, practices and attitudes with regard to the situation of children and women in Lebanon. The indicators address issues like health, WASH, education, child protection, GBV, disabilities and child rights. Three methods were employed for data collection: a national survey consisting of questionnaire interviews with 7,000 households; 48 focus group discussions or FGDs; 42 key informant interviews or KIIs. This mixed-method approach, in which the quantitative method of questionnaire interviews is mixed with the qualitative methods of FGDs and KIIs, allowed for reciprocal contextualization: quantitative data provided context for qualitative data and vice versa. More specifically, in analysis, qualitative data regularly provided substantive context for quantitative data, while quantitative data at times limited the validity of qualitative results.

2.1. Management of the study The administrative framework for the research part of the KAP Study was Orecomm, an international centre for research in the field of C4D at Malmö University, Sweden. Malmö University already held a long-term arrangement for services with UNICEF. All funds made available to Orecomm for the KAP Study were managed by Malmö University. Orecomm assembled the following team to conduct the KAP Study: • • • • • •

Ronald Stade, team leader, Professor of Peace and Conflict Studies with specialization in Anthropology at Malmö University Lana Khattab, principal researcher and project coordinator, MSc in Middle East Politics from SOAS, University of London Erik van Ommering, principal researcher, PhD candidate in Anthropology at Vrije Universiteit Amsterdam and Caritas Austria’s education advisor in Lebanon Rabih Haber, principal researcher, DEA in Political Science, MSc in Statistics and Applied Mathematics, and general manager of Statistics Lebanon Ltd. Samah Ahmed, project manager, adjunct lecturer at Malmö University; Bsc in Biomedical Sciences, Kingston University, UK Oscar Hemer, project assistant (advisor), Professor of Journalistic and Literary Creation at Malmö University, co-director of Orecomm

On a short-term basis, a number of field researchers and analysts were also included to conduct household interviews and to tabulate results. Technical, methodological and ethical training took place from 27 to 28 April for field researchers who were to conduct household interviews and on 3 May for facilitators of FGDs. All field staff had previous experience from conducting household interviews with questionnaires and/or FGDs. All research instruments were pre-tested in the mohafazat of Beirut and Mount Lebanon and evaluated and validated by the research team.

27

2.2. Ethical considerations This section contains a discussion of the ethical standards and procedures for the KAP Study.

2.2.1. Ethical principles in research involving human beings The KAP Study was conducted in accordance with ethical standards and procedures as defined in UNICEF Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis (CF/PD/DRP/2015-001), which went into effect on 1 April 2015. Like most fundamental legal and steering documents on research ethics, this UNICEF document invokes two ethical principles: on one hand, deontology and, on the other, consequentialism. In the KAP Study, the inconsistency between the two types of ethics is dissolved by declaring deontology to be the first principle and consequentialism to be subordinate to this first principle. That is, the protection of personal security and integrity, human rights, child rights and human dignity has been considered paramount. It took precedence over any general benefit of research more generally and of the KAP Study more specifically.

2.2.2. Ethical risks The country office of UNICEF in Lebanon has identified two gaps in the available evidence on child rights, child survival, child protection and social inclusion in Lebanon: (1) a lack of current baseline data and (2) a lack of an updated C4D strategy developed from the new baseline. To fill these gaps, the KAP Study collected primary, sensitive personal data, which will be used as a baseline for UNICEF Lebanon’s Country Programme Document for 2017-2020, hereafter CPD 2017-2020. The discussion of ethical risks in the current document is therefore limited to potential risks issuing from data collection and analysis and the communication of results. In accordance with the definitions provided in the UNICEF Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis, the following discussion focuses on the four ethical risk topics: • • • •

Assent and informed consent Privacy and confidentiality Harms and benefits Risk management

2.2.3. Assent and informed consent The participation of all research subjects in the KAP Study was voluntary. No exercise of undue inducement or any other form of constraint or coercion to participate in the study was permitted or accepted. Research subjects could withdraw from the study at any point without being asked for or having to provide an explanation and without any disadvantage following from their withdrawal. Easy to understand information was provided on who and on whose behalf the study was conducted, the purpose of the study, that participation in the study is voluntary, that it would be possible to withdraw at any point without any negative consequences, and whom to contact after data collection for questions, comments and the withdrawal of consent. (For further details and information and consent forms that were used, see Appendix A.) Participants who were children, that is, minors below the age of 18 years, received age-appropriate information and were asked for consent. Children aged 15 years and older were, for the sake of obtaining informed consent, treated like adults. For children younger than 15 years, their assent or informed consent was necessary for their inclusion in the study. Had a child dissented or declined to

28 participate in the study, but the parent or caregiver consented to the child’s participation, it would have been the child’s dissent or declination that would have determined whether to include the child in the study. In other words, the child’s decision to not participate would have invalidated the parent’s or caregiver’s decision for it to participate. If, on the other hand, the child assented to participate in the study, the parent’s or caregiver’s consent was still needed. (For information and consent forms, see Appendix A.)

2.2.4. Privacy, confidentiality and data security A common mistake among researchers is to guarantee research subjects absolute confidentiality. Such promises are misleading because even the most stringent measures to ensure confidentiality will not guard against violations of laws and rules and the unforeseen. This caveat notwithstanding, appropriate measures were taken to protect confidential information and sensitive data. Data collectors were trained in the basics of research ethics. All data were collected and stored with encryption. All quantitative data were analysed and communicated as aggregates. Neither survey interviews nor FGDs nor KIIs were recorded with audio or video devices. Qualitative data could therefore be anonymized already during data collection. An Agreement on the Sharing of Personal Data of Refugees, Asylum-seekers and other persons registered with UNHCR was signed between Malmö University and the Office of the United Nations International Children Emergency Fund (UNICEF). The degree of privacy during data collection depended on the method used. Survey interviews were often conducted in the household of the participant; this guaranteed a rather high level of privacy. There was obviously less privacy during FGDs. Participants in the FGDs were, however, reminded to keep the information exchanged during the FGDs confidential (see FGD guidance form in Appendix C). Taking into consideration hierarchies and relationships of dependency, KIIs were conducted individually and behind closed doors.

2.2.5. Harms and benefits At the individual level, potential harms to research subjects resulting from their participation in a study vary with their ability to preserve their integrity and dignity and defend their rights. The less they possess this ability, the higher the risk for potential harms. Since this study targeted vulnerable groups – for example, refugees and children – close attention had to be paid to minimizing the risk for harms. One measure to accomplish this was the basic training in research ethics that was part of the training of data collectors. Another measure was to maximize levels of privacy and confidentiality (see previous heading). At the communal level, potential harms are likely to be of a structural nature. Preventing structural harms, for instance in the shape of structural violence, is primarily a policy issue, but it also informs the communication of results and the recommendations included in this report. Harm prevention also included making sure that field research was conducted in accordance with the ethical standards that Orecomm commits to in this document and that data collectors were qualified and competent to ensure a high level of research quality. Both requisites were met by (a) the systematic training of all data collectors and (b) the supervision and back-checking of all data collection activities by Orecomm’s principal researchers and UNICEF’s zonal office SMOs (Statistics and Monitoring Officers).

29

2.2.6. Risk management Team leader Ronald Stade and principal researcher Rabih Haber share the responsibility for risk management. Under the preceding headings, we discussed the work we did to ensure ethical conduct and risk management during data collection. Here, we add information on risk management during data analysis and with regard to data storage more generally. All project data were, are and continue to be protected from physical damage, as well as from tampering, loss or theft, by limiting access to data. Only immediately involved and responsible project members were and continue to be authorized to access and manage stored data. Any data obtained from external sources such as UNHCR are encompassed by the same strict and specific measures for protecting personal data.

2.2.7. Child rights While child rights are human rights, the UN Convention on the Rights of the Child grants special protection to children and young people under the age of 18. Both the purpose and the methodology of the KAP Study were formulated from a child rights perspective. The purpose of the study was to create a baseline for CPD 2017-2020, which will inform UNICEF Lebanon’s actions to overcome barriers to child survival, child protection and the social inclusion of children and their families. The methodology used in the study was inclusive of children and their families, with a representative distribution in terms of gender (boys and girls) and age. In particular, the FGDs with children served to give voice to children in accordance with Articles 12, 13 and 14 of the Convention on the Rights of the Child. A priority area of the study was the right to inclusion of children with physical and/or mental disability.

2.2.8. Gender perspectives Gender perspectives can be applied to the two groups involved in this study: researchers and research subjects. The research team was gender balanced, with the division of responsibilities as equally divided as possible. Gender balance among research subjects was accomplished through adopting strategic criteria for inclusion. That is, gender balance was an explicit goal of sampling. Furthermore, we ensured that locations for FGDs were easily accessible for women and that the date and time for FGDs was set so as to not interfere with women’s routines. The KAP Study itself contributes to gender perspectives in that it collects and analyses data on issues like GBV and child protection. Anonymized data are disaggregated according to gender, which provides a baseline for gender policies and actions.

2.3. Definition of sampling levels 2.3.1. Domains In the absence of an official census, the population size of Lebanon can only be estimated but not stated with precision. The size of certain population groups in Lebanon, however, is easier to determine than others. This is particularly true of those groups who live in Lebanon and are registered with the Lebanese government and/or with UN agencies who are responsible of registration activities such as UNHCR and UNRWA. Registered Syrian refugees in the UNHCR database are 1,001,051 as of June 2017.

30 Palestine refugees are supported by UNRWA. If UNRWA’s numbers and estimates for each of the 12 designated camps are added together one can conclude that approximately 190,000 Palestine refugees live in camps in Lebanon. The number of Lebanese citizens living in Lebanon is difficult to assess, but according to Statistics Lebanon Ltd. a reasonable estimate, based on previous surveys, is 4,877,000. The just mentioned four population groups – Lebanese citizens, registered Syrian refugees, Syrian refugees living in ISs and Palestine refugees living in camps – were selected as domains for the KAP Study. The names of the four domains are derived from the databases used to sample them and the inclusion criteria applied for sampling. • • •

•

Lebanese domain: An estimate by Statistics Lebanon Ltd. was used to arrive at a total of Lebanese residents. Registered Syrian refugee domain: UNHCR provided lists from which were excluded Syrian refugees living in ISs. Therefore, the relevant criterion for inclusion in the domain is registration with UNHCR. Syrian refugees living in ISs: The statistical framework for this domain is the Inter-Agency Mapping Platform (more specifically, IAMP February 2017). Hence, the defining attribute for inclusion was not registration with UNHCR, but IS clusters and their location. Palestine refugee domain: The inclusion criterion was registration with UNRWA and residence in one of Lebanon’s twelve designated Palestine refugee camps. No differentiation was made between PRL (Palestine refugees in Lebanon) and PRS (Palestine refugees in Lebanon from Syria).

2.3.2. Mohafaza As of August 2017, Lebanon was divided into eight governorates or mohafaza. The eight mohafazat differ on a number of accounts: population size and density, topography, infrastructure, security, and so on. Sparsely populated tracts in the northern and north-eastern parts of Akkar and Baalbek-Hermel contrast with the densely populated urban sprawl that stretches along Lebanon’s Mediterranean coast. Access to services varies accordingly. While, in urban areas, services usually are not far away, demand is likely to be higher, which can result in supply bottlenecks. In sparsely populated areas, transportation to and from services might be a more prominent problem.

31

Centre and periphery In terms of demography, infrastructure and public services, Lebanon is divided into a more populous centre and a less populous periphery. KAP Study data show that the mohafaza of Akkar and Baalbek-Hermel exhibit periphery characteristics such as a low degree of state penetration and a higher degree of self-reliance for services and conflict resolution.

2.3.3. Households A household is a unit in which one or more persons share a domestic space and meals from the same income. In Lebanon, just like in the rest of the world, the size and composition of households varies. A noteworthy observation resulting from the KAP Study is that the large-scale movement of Syrian refugees to Lebanon has had remarkably little overall effect on the composition of households in Lebanon.

2.4. Sample design 2.4.1. Sample size The quantitative part of data collection consisted of n=7,000 household interviews, which targeted • • • •

n=5,100 Lebanese residents n=1,211 Syrian refugees registered with UNHCR n=281 Syrian refugees living in informal settlements, defined as consisting of 4 or more tents n=408 Palestine refugees living in camps.

32 These numbers represent a Probability Proportionate to Estimated Size (PPES) sample that is based on demographic estimates for each of the four domains: • • • •

Lebanese residents: 4,035,042 or 4,877,0002 Syrian refugees registered with UNHCR: 1,001,051 Syrian refugees living in informal settlements: 220,0003 Palestine refugees living in camps: 190,0004

For the qualitative part of the study, the issue of sample size was less relevant. Nevertheless, a relatively large sample size of FGDs was chosen to guarantee a representative distribution of groups. KIIs were selected across various levels of decision-making and implementation, and across all eight mohafazat. The sample size for the KIIs proved to be sufficient insofar as the results exhibit a high degree of detailed information, converging attitudes, as well as perspectival variation on all indicators. Inclusion criteria • • • • •

Respondents of both genders were interviewed Respondents had to be at least 18 years of age Respondents had to live in households with children Respondents were either self-identified heads of household or primary caregivers or both Respondents belonged to one of the domains of Lebanese residents, Syrian refugees registered with UNHCR, Syrian refugees living in informal settlements and Palestine refugees living in camps.

All three methods employed in this study include self-reported data, which is a potential source of bias and mismeasurement. Apart from common psychological biases in self-reporting, the KAP Study is limited by the participants’ measure of trust in the confidentiality with which their information will be processed. This and related issues were addressed in the training of data collectors who were to work in the field. Sampling errors are included as Annex A.

2.4.2. Quantitative sample5 Mohafaza

Akkar

Lebanese residents 6.32%

Syrian refugees registered with UNHCR

Syrian refugees living in ISs

9.74%

12.63%

Palestine refugees living in camps

2

The first figure is from the Lebanon Crisis Response Plan 2017-2020. The second figure is an estimate by Statistics Lebanon Ltd. 3

Syrian refugees residing in informal settlements may very well be registered with UNHCR, but to disaggregate the numbers, the statistical framework for Syrian refugees residing in informal settlements is the Inter-Agency Mapping Platform (more specifically, IAMP February 2017). Thus, the defining attribute for inclusion was not registration with UNHCR, but IS clusters and their location. 4

Aggregate of UNRWA’s numbers for the 12 designated Palestine refugee camps in Lebanon.

5

For a detailed account of quantitative sample and error analyses, see Annex A at the end of this chapter.

33 North

13.84%

14.96%

3.78%

23.28%

Bekaa

6.88%

23.33%

44.52%

Baalbek-Hermel

6.59%

12.13%

35.64%

Beirut

10.07%

2.41%

0.02%

Mount Lebanon

37.64%

25.86%

0.68%

25.25%

South

11.79%

7.15%

0.97%

50.25%

Nabatieh

6.88%

4.42%

1.76%

1.23%

Table 2.1: Quantitative distribution of domains by mohafaza in Lebanon

2.4.2.1. Residents of Lebanon – sample The sample for Lebanese citizens was selected in two stages. The first stage involved utilising the available layer of mohafaza, which has counts of dwellings6 and clusters.7 This was the first stage sample frame. Thereupon followed a Probability Proportionate to Estimated Size (PPES) sample of mohafaza, where the measure of size is the number of citizens by mohafaza. In the second stage sample frame, a systematic choosing sample was drawn based on cluster distribution.

2.4.2.2. Registered Syrian refugees – sample The sample for Syrian refugees registered with UNHCR was selected in three stages. The first stage involved performing a systematic choosing technique on a database of telephone numbers of registered Syrian refugees supplied by UNHCR, filtered by residence type, which excluded Syrian refugees living in ISs, and divided by area of residence. Based on the numbers obtained through the filtering activity, a sample of respondents for each of the eight mohafazat was drawn based on the domain’s representation in each mohafaza out of the total sample. The second stage sample frame applied a PPES technique, in which a correct representation of refugees in each mohafaza was accomplished. The third stage ensured that the number of households (HH) needed from each selected cluster was proportional to the total number of HH contained in each selected cluster. Upon the selection of the sample, a team of telephone interviewers used a filtering questionnaire to ensure that the selected respondents met the inclusion criteria, after which a date and time for the interview was agreed upon. For each cluster, enumerators were given additional mobile phone numbers to achieve the required sample size because some phone numbers were unreachable, some HH did not meet the inclusion criteria or had changed residence to another mohafaza.

2.4.2.3. Syrian refugees living in ISs – sample The sample for Syrian refugees residing in ISs was also selected in two stages and based on random sampling. The first involved utilising a cluster distribution based on criteria of an IS consisting of ten or more tents. The second stage involved a systematic choosing technique with a skip pattern, which guaranteed obtaining unbiased estimators for the parameters of interest. Inside the clusters, tents were chosen using the same logic of skipping and choosing clusters.

2.4.2.4. Palestine refugees living in camps – sample The sample for Palestine refugees residing in designated camps was selected in three sample stages. 6

Based on CAS data 2004

7

Based on Statistics Lebanon’s distribution

34 In the first stage, each camp was divided into virtual clusters that were drawn based on geographical layers provided by UNICEF/UNRWA, where each cluster was numbered and a skip pattern drawn from each of the camps based on the total number of clusters and the required number of clusters during the activity. In the second stage, up to ten HH were targeted in each cluster. Where the sample was less than ten persons inside a camp, it was included to form one cluster only. In the second stage, the number of HH per selected virtual cluster was estimated, based on the estimated number of buildings, number of floors per building and number of homes per floor. The third and final stage utilised systematic sampling to select HH that met the inclusion criteria.

2.4.3. Qualitative sample 2.4.3.1. Focus group discussions A total of 48 FGDs were held in different locations and with members of the four domains across Lebanon on the indicators for UNICEF’s programmatic areas. The distribution of FGDs was organized according to indicator and target group. The aim was to acquire comparative data. Where possible, the sampling of FGDs has been based on the statistically representative clusters for each domain. For a full matrix of the distribution of FGDs, please see Appendix D. FGDs Parents Caregivers Children Lebanese residents total 11 1 9 Lebanese residents male 5 0 4 Lebanese residents female 6 1 5 Registered Syrians with UNHCR total 7 1 7 Registered Syrians with UNHCR male 3 0 4 Registered Syrians with UNHCR female 4 1 3 Syrians living in ISs total 4 0 1 Syrians living in ISs male 2 0 0 Syrians living in ISs female 2 0 1 Palestine refugees total 6 1 0 Palestine refugees male 2 0 0 Palestine refugees female 4 1 0 Total 28 3 17 Table 2.2.: Distribution of FGDs based on the characteristics of participants and domain

Total 21 9 12 15 7 7 5 0 0 7 3 5 48

The inclusion criteria were as follows: • Parents: biological father and mother of children • Caregivers: biological father and mother of children as well as caretakers of non-biological children (e.g. niece, nephew, grandchild) • Children: between ages 9 to 17 years. Groups were divided between 9 to 12 and 13 to 17 years.

2.4.3.2. Key informant interviews The target groups for KIIs were divided by programme area and along national, regional and local levels. They included decision- and policy makers as well as practitioners working hands-on with the

35 issues relevant to this study. The methodology for the KIIs took into consideration the chain of decision-making and implementation in each programme area. This allowed for an in-depth look into how decisions at the policy level translate into programmatic actions that are executed by different actors down the chain, highlighting challenges to implementation and adaptations to local contexts faced in the field.

2.4.4. Research instruments and data collection 2.4.4.1. Survey The instrument used to elicit quantitative data was a questionnaire (drafted in English and translated into and used in Arabic) jointly developed by the research team, UNICEF Lebanon’s programme sections (WASH, child protection, education, health, disabilities, social inclusion, Palestinian programme and C4D) and representatives of the Ministry of Social Affairs (MOSA), the Ministry of Public Health (MOPH) and Ministry of Education and Higher Education (MEHE). The entire questionnaires in both English and Arabic can be found in Appendix E. The questionnaire interview was designed to take no longer than 60 minutes to complete, in order to not take up too much of the respondents’ time. Quantitative data collection took place between 28 May and 30 July 2017, by 33 enumerators and 5 supervisors. Each supervisor was on average responsible for a team of 6 enumerators. Data collection was centrally monitored by the research team to ensure that all clusters were visited. Moreover, UNICEF SMOs visited field locations with data collectors in July 2017.

2.4.4.2. Focus group discussions Detailed FGD guides and a detailed questionnaire were developed, both of which included the key lines of inquiry of the KAP Study. The questionnaire was developed in close collaboration with UNICEF KAP focal points and tailored to the specific information requested by UNICEF programmes. The guide for FGDs with children was adapted from that for adults by using a photo elicitation method instead of just verbal cues. Photo elicitation is based on the rather elementary idea that images evoke deeper elements of human consciousness than words and that they can serve both as common focal points and as triggers for communicative action. The photo elicitation method has proven especially fruitful with children as images facilitate interaction and probing. The pictures were carefully prepared and only pictures with a non-commercial license were chosen by the researchers, printed out on A3 foamboards and used in all FGDs with children. There were between 6 and 15 participants in each FGD. Each FGD lasted between 60 and 120 minutes. The locations for the FGDs were adapted to the context. They included the office of Statistics Lebanon in Beirut, NGO spaces, private homes and tents in ISs. Qualitative data collection using FGDs took place between 6 May and 16 June 2017 and was conducted by, in all, six researchers. Each FGD was led by one facilitator and one note-taker. UNICEF zonal offices and partners assisted in the organization of a number of FGDs inside ISs and NGO centres in the mohafazat of Akkar, Bekaa and Baalbek-Hermel.

2.4.4.3. Key informant interviews A KII guide was developed based on broader lines of inquiry for each topic. The semi-structure of the KIIs allowed for relative flexibility in gathering data based on the most pressing issues and needs of respondents. However, all KIIs provided information about the specific issue at hand, a contextual overview, challenges faced and how they might be overcome. The settings for KIIs were diverse and depended on the key informant. They included key informants’ offices, such as at ministries, NGO offices, PHCs, MOSA/SDCs and UNICEF zonal offices. Qualitative data collection with KIIs began 23

36 March 2017 and was concluded on 25 August 2017. The original plan was to conduct 24 KIIs in all; however, the research team decided to extend data collection in order to follow the vertical chain from decision-making to implementation and conducted 42 KIIs.

2.4.5. Training Training on the quantitative survey questionnaire took place on 27 and 28 April 2017 at Padova Hotel in Sin el Fil, Beirut. The training focused on the objectives and contents of the survey, included child protection and gender-based violence (GBV) sessions and provided an overview on the referral mechanism to be used during the study. The training on the qualitative FGDs questionnaires took place on 3 May 2017 in Statistics Lebanon’s office in Dekwaneh, Beirut. The training focused on the objectives of the study, the photo elicitation method, the qualitative research tools, included child protection and GBV sessions and gave an overview on the referral mechanism to be used during the study.

2.4.6. Data processing and analysis Quantitative data were collected using tablets and computer-assisted personal interviewing (CAPI). Internal consistency checks were performed for quality assurance purposes. Data processing began simultaneously with data collection in May 2017 and was completed in August 2017. The data were processed and analysed using the Statistical Package for Social Sciences (SPSS) software version 22. The most relevant nodes were UNICEF’s indicators, the domains, gender, age, and mohafaza or geographical location. Results from the analysis of the data were presented in the form of frequency tables, cross-tabulations and graphs. Qualitative data were collected using note taking in real time. The notes were uploaded to, and encoded with, the NVivo software version 11.4.1. Encoding was done using nodes, node matrices and case classifications. The most relevant nodes were UNICEF’s indicators, the domains, gender, age and mohafaza.

37

ANNEX A. Sampling error and design effect The sampling error in any survey using probability sampling is given using: E=1.96*sqrt(P*(1-P)/n)* sqrt (deff) Where, P= the percentage of a parameter of interest and (n)= sample size. Deff= design effect due to clustering, that is using cluster sampling instead of simple random sampling. Assuming the target population is most heterogeneous concerning a certain parameter let P=0.5, then for: • • • •

Lebanese: n=4,370 and design effect of 1.5, the desired margin of error will be E=+/- 1.48%. Syrian refugees registered with UNHCR: n=1,211 and design effect of 1.5, the desired margin of error will be E=+/- 2.81%. Syrian refugees in informal settlements: n=281 and design effect of 1.5, the desired margin of error will be E=+/- 5.84%. Palestine refugees: n=408 and design effect of 1.5, the desired margin of error will be E=+/- 4.83 %.

Error ratios increase results are cross-tabulated.

38

3. HOUSEHOLD CHARACTERISTICS This chapter describes the demographic and socio-economic characteristics of the four domains in the sampled households. A household, hereafter abbreviated as HH, is a unit in which one or more persons share a domestic space and shares meals from same income. The following sections examine characteristics related to the gender, age and marital status, disability, occupation and education levels of interviewees and HH-members. Data about the economic situation of the HH were collected through questions about housing facilities, including co-habitation with different families, and the number of rooms in each residence. This information on the characteristics of the surveyed population is vital for interpreting the survey findings. This chapter provides first an overview of the total sample, after which each domain will be examined separately. As outlined in Chapter 2, the sample size for the KAP Study survey was 7,000 HHs divided by four domains proportional to population size: 5,100 Lebanese residents’ HHs, 1,211 Syrian refugees registered with UNHCR HHs, 281 Syrian refugee HHs living in ISs (of 10 or more tents) and 408 Palestine refugee HHs living in designated Palestine refugee camps. Out of all respondents interviewed, 78% were Lebanese, 16% were Syrian refugees and 6% were Palestine refugees.

3.1. Characteristics of HHs: Overview Respondents profile and HH composition Information about the survey respondents by gender and domain is presented in table 3.1. In total, 93% of respondents are female and 7% are male. The vast majority of total survey respondents are female, with the lowest rate being for Palestine refugee respondents at 88% and the highest rate being for Syrians in ISs at 98%. Out of the total number of respondents, 51% are aged 36-55 years, while 42% are 18-35 years and 7% are 56 years and older.

Syrians informal settlements

98%

2%

Palestinians

88%

12%

Syrian registered

6%

Lebanese

7%

94% 93% Female

Male

Table 3.1: Gender of total respondents by domain and by gender Information about the composition of HH by the gender of the HH-head is presented in table 3.2. The KAP Study data show that the majority of HHs are headed by men, with the highest proportion for Lebanese at 90% and the lowest for registered Syrians at 85%. In total, 89% of HHs are headed by men compared to 11% headed by women. Out of all 7,000 HHs, 63% of HH-heads are 36-55 years of age, 27% are 18-35 years and 11% are 56 years and older.

39

Syrians informal settlements Palestinians Syrian registered Lebanese

14%

86%

13%

87%

15%

85%

10%

90% Female

Male

Table 3.2: Gender of HH-heads by domain and by gender Most HHs continue to consist of a single family at almost 95%. While 86% of HHs have 3-6 members, around 12% consist of 7 members and over and around 2% consist of just 2 members. HH population by gender, age and marital status The total of 7,000 HHs successfully interviewed for the KAP Study are composed of 34,711 persons; 17,703 are female, representing 51% of the sample, while 17,008 are male, representing 49%. The age structure for all domains indicates that a larger proportion of the population falls into the younger age groups. Syrians in ISs have the highest number of children between 0-13 years of age at 51%, followed by registered Syrians at 47%. At 16%, Palestine refugees have the highest percentage of adults aged 26-35 years, followed by registered Syrian respondents at 15%. At 26%, Lebanese have the highest percentage of adults aged 36-55 followed by Palestine refugees at 22%. Moreover, most children live in the same HH as their biological parents. Children who were looked after by caregivers, because their biological parents were not living in the same HH, are mostly Syrian. 8% of children in Syrian HHs did not live together with their biological father.


90%

Palestinians Syrian registered

8% 93%

90%

Lebanese

2% 6%

8% 94%

1% 2% 4%

Yes both live in the household

Mother yes, father no

Father yes, mother no

None live in the household

1% 1%

Table 3.3: Biological mother/father of children 0-17 years living in the HH by domain As shown in table 3.3, out of the total of 34,711 HH-members, 57% are not married, 39% are married and around 4% are either widowed, divorced or engaged. Syrians are the only domains in which family members in the age bracket 14-17 years are reported married. They consist of 3% for registered Syrians and 2% for Syrians in ISs. In the age bracket of 18-25 years, the highest proportion of marriages can be

40 noted for Syrians; in ISs at 64% and for registered Syrians at 49%, while the lowest can be noted for Lebanese at 19% and for Palestine refugees at 18%. A more detailed breakdown of marital status is found in the sections below by domain. Not married

57%

Married Widowed

39% 2%

Divorced

1%

Engaged

1%

Table 3.4: Marital status of HH-members for all domains Educational level of HH population Education can be an indicator of certain aspects of an individual’s life, including demographic and health behaviour, and can help shed light on explaining certain knowledge gaps, attitudes and practices of individuals. Around half or 53% of the total number of respondents cited primary and complementary schooling as the highest completed educational levels. Clear differences can be noted in the educational attainment of respondents across different domains and gender. The starkest gender differences can be noted among Palestine refugees. While 46% of female respondents cite primary education as the highest completed educational level, only 27% of male respondents do so. Palestine refugees also have the highest gender difference of respondents having completed university as highest educational attainment, with 16% of men completing it compared to only 10% of women. Complementary (cycle 3)

30%

Primary (cycle 1&2)

23%

University

19%

Secondary

16%

Never been to school

6%

BT, TS or LT BP

5% 1%

Table 3.5: Highest educational levels completed by total respondents Among Syrian domains, more female (18%), than male respondents (12%), have never been to school. More men (47%) than women (37%) have cited primary education as the highest completed educational level. The most gender equal results among male and female respondents can be found among Lebanese, where differences are at most 2% between each level of educational attainment. The lowest educational attainment rates can be found among Syrians in ISs, where 30% of male respondents and 34% of female respondents have never been to school. The highest educational attainment rates are to be found in the Lebanese domain, where 19% of respondents have completed secondary school and 24% have completed university education. For Lebanese and registered Syrians, educational attainment is higher in more urban mohafaza than in rural ones.

41 Housing characteristics


100%

Palestinians

57%

Syrian registered

32%

38%

Lebanese

35% 57%

8% 2% 20%

7%

43%

Purpose-built apartment

Purpose-built house

Formal settlement

Substandard building

Purpose-built villa Informal settlement

Table 3.6: Housing arrangements by domain Data on HHs’ housing characteristics indicate socio-economic status and vulnerability of individuals and families in question. Aside from Syrians living in ISs, where all interviewed HHs live in tents, 100% of Lebanese, 89% of Palestine refugee and 73% of registered Syrian HHs live in either purpose-built apartments or houses. While 8% of interviewed Palestine refugee HHs live in formal settlements, 20% of registered Syrian respondents’ HHs constitute formal settlements and 7% constitute substandard buildings, indicating an increased level of vulnerability and precariousness.


89%

1%

Palestinians Syrian registered

10%

97% 90%

Lebanese

1%

1% 9%

96%

Family alone

Lebanese relatives

Palestinian relatives

House keeper(s), maid(s)

2% 1%

4%

1%

Syrian relatives A Syrian host family (non-relatives)

Other refugee family(ies)

Table 3.7: HHs sharing their housing by domain 95% of HHs interviewed for the KAP Study were single-family HHs. Around 10% of Syrian respondents registered with UNHCR and Syrian respondents in ISs share their home with one or more families, who are predominantly Syrian relatives. The highest proportion of shared housing facilities among registered Syrian HHs were found in Beirut and Mount Lebanon at 17% for both. A similar trend, but with fewer numbers at 2% in Beirut and 6% in Mount Lebanon, was found for Lebanese HHs, indicating a centre-periphery difference that, because of a lack of available living space, higher prices or perceived protection risks, drive families to share housing.

42

Palestinians Syrian registered Lebanese

13% 3%

53% 20%

31% 55%

44%

Over three rooms

23% 39%

Three rooms

3%

Two rooms

15% 2%

One room

Table 3.8: Rooms in the HH by domain excluding bathroom and kitchen Information on the number of rooms for each HH by domain indicates certain trends in HHs’ economic situation. Lebanese HHs had the best economic profile in comparison to other domains, with 83% of HHs having three or more rooms. In comparison, 66% of Palestine refugee HHs have three or more rooms. Of respondents living in structures that have rooms, registered Syrian respondents represent the most economically vulnerable population group, with only 23% of HHs having three or more rooms, compared to 55% of HHs having two rooms and 23% only one room. The most vulnerable domain in terms of living space is of course that of Syrians living in ISs.

HH population’s engagement in paid activity Respondents were interviewed about all HH-members’ engagement in paid activity to gage the socioeconomic situation of the population groups in question. Overall, most family members are not engaged in paid activities. Critically, over three times more, or 39% of, male HH-members than female HH-members (12%) are engaged in paid activity. Of the total of HH-members who are working, the highest percentage or 32% report to be self-employed, indicating that they are potentially not financially stable. Around 20% are service and sale workers in shops and around 10% are handcrafters and just as many are state employees. Disabilities Only 1% of the total HH-members are reported to have a disability. The low number indicates that there might be a confusion of categories and uncertainty as to what constitutes a disability among respondents, a finding that has been validated by the qualitative research. The lowest reported number of HH-members with disability were among Lebanese; the highest were among Syrians registered with UNHCR.

43


39%

Palestinians

22%

43%

Syrian registered

12%

11%

10%

54%

Lebanese

17%

36%

19%

12%

22%

18%

6%

6%

10%

12%

11%

4% 4% 2%

1% 5% 3% 2% 1%

9%

5% 4%2% 2%

Motor (Walking and hand function)

Intellectual

Hearing

Seeing

Learning Difficulties (e.g. Dyslexia)

Combined Disabilities

Autism/Asperger’s

Psychiatric / mental health disorders

Down syndrom

Table 3.9: Type of disability of HH-members by domain For the five lower age groups (0-13 years, 14-17 years, 18-25 years; 26-35 years and 36-55 years), percentages of reported HH-members with disability fluctuated between 1 and 3%. The age group with the highest proportion of disabilities is the eldest one with 55 years and over, where the percentage fluctuates between 2% for Palestine refugees and 7% for registered Syrians. Moreover, Syrians have the fewest available caregivers to support HH-members with disabilities, while Palestine refugees have the most. Nonetheless, the proportions are very low for all domains, indicating a high vulnerability for individuals with disability.

Syrians informal settlements Palestinians Syrian registered Lebanese

78%

17%

65%

27%

78%

No

8%

20%

73%

25% Yes

6%

2% 3%

Sometimes

Table 3.10: Availability of caregiver for HH-members with reported disability by domain

3.2. Characteristics of HHs: Lebanese domain Respondents profile and HH composition While survey respondents are overwhelmingly female at 93% compared to 7% male respondents, the heads of HH are mostly male at 90% compared to 10% female. Of those 90% male HH-heads, almost 70% are 36-55 years old; and of the 10% of female HH-heads almost 60% are 36-55 years old.

44 Moreover, of the 93% of female respondents, around half are 36-55 years and around a third are 2635 years old. Of the 7% male respondents, over half are between 18-25 years old.

56 yrs and over

36-55 yrs

11%

18%

68%

Female

59%

18-35 yrs

22%

Male

24%

Table 3.11: Lebanese HH-heads by gender On a mohafaza level, the highest percentage of female interview respondents, at 97%, were in Bekaa, closely followed by the North at 96%. In contrast, the two highest percentages of male interview respondents are in Nabatieh at 11% and in Mount Lebanon at 10% respectively. Regarding the gender of HH-heads, the highest percentage of male-headed HHs at 92.8% was found in Bekaa, followed by the North with 91%. Beirut has the highest percentage of female-headed HHs at 14.5% followed by South at 11.5%. HH population by gender, age and marital status The total of 5,100 Lebanese HHs successfully interviewed for the KAP Study are composed of 28,890 persons; 14,734 are female, representing 51% of the domain, while 14,156 are male, representing 49%. Most Lebanese HHs have 4-5 HH-members. The highest proportion of smaller HHs composed of 2-3 members is found in Beirut at 28%, while the highest proportion of HHs composed of 4-5 members is found in Bekaa and Mount Lebanon. Almost half of Lebanese HHs in Akkar are composed of 6 and more persons, representing the highest proportion among all mohafazat.

South North

13%

56%

23%

Mount Lebanon

21%

El Nabatieh

20%

Bekaa

20%

Beirut Baalbek-El Hermel Akkar

44%

32%

60%

19%

53%

27%

61%

28%

19%

55%

25% 15%

31%

17%

53% 38%

2-3

21% 47%

4-5

6 and more

Table 3.12: Total number of Lebanese HH-members by mohafaza The age structure for the Lebanese domain is relatively evenly distributed. Children between 0 and 17 years constitute 43% of the total number of family members. There is an equal number of HH-members

45 18-35 years and 35-55 years with 26% each. With only 5% of HH-members at the age of 55 years or older, the Lebanese population is comparatively young.

5% 33%

26%

13%

10% 13%

0-13 years

14-17 years

18-25 years

26-35 years

36-55 years

55+ years

Table 3.13: Age of all HH-members for the Lebanese domain Moreover, 94% Lebanese children under 18 years live in the same HH as their biological parents, while 4% live only with the mother. A small fraction of Lebanese children, at 1%, does not live with their biological parents but instead lives with other caregivers. While around 20% of Lebanese aged 18-25 years are married, almost 90% of 26-35 year olds are married. This trend stays consistent as respondents get older, with 95% of 36-55-year-old Lebanese being married.

53% Female

1% 1% 3% 41% 57%

1% Male

Not married

Engaged

Divorced

Widowed

41% Married

Table 3.14: Marital status of HH-members in the Lebanese domain Educational level of respondents Lebanese respondents have the highest and most gender-equal educational attainment results among all domains. While 2-3% have never been to school, the highest educational completion for 16-18% of Lebanese respondents is primary education (cycles 1 and 2), for 30% it is complementary education (cycle 3). Around 20% have completed secondary education and 7% have completed Brevet Professionel (BP), Baccalaureat Technique (BT), Technicien Supérieur (TS) or Licence Technique (LT). 24% of both female and male respondents have completed a university education.

46 The highest level of educational attainment, if the percentages for a completed secondary and university education are added, is found in Mount Lebanon (50%), followed by Bekaa (43%). The highest proportion of respondents who have never attended school is in Akkar at 10%, followed by Nabatieh. Overall, Akkar has the lowest educational attainment numbers, followed by the mohafazat of North and Baalbek-Hermel.

South

2% 14%

North

3%

Mount Lebanon El Nabatieh

23%

5% 1% 15%

Beirut

3%1%

Akkar

27% 21%

21% 30%

25% 38%

23%

2%5%

1%7%

18% 29%

14% 2% 5% 21%

27%

20%

1%7%

19%

32%

1% 13% 10%

17% 29%

1% 13%

Bekaa

Baalbek-El Hermel

37%

1%7%

20% 16%

1%2%

2% 9%

34%

14% 2% 6%

23% 22% 21% 20% 13%


Preschool

Primary (cycle 1&2)

Complementary (cycle 3)

Secondary

BP

BT, TS or LT

University

Table 3.15: Highest level of educational attainment of Lebanese respondents by mohafaza Housing characteristics Lebanese HHs surveyed for the KAP Study reside in two types of housing: 57% live in purpose-built apartments and 43% live in purpose-built houses. The majority of Lebanese HHs, 96%, live with their families alone and 4% live with Lebanese relatives. From the total HHs interviewed, 83% have three rooms or more, while 15% have two rooms and 2% have only one room. Those with the lowest number of rooms, in all 17%, may be considered the most socio-economically vulnerable. HH population’s engagement in paid activity The highest proportion of Lebanese HH-members who are engaged in paid activity is in the age groups 26-35 years (57%) and 36-55 years (62%). Of the total Lebanese HH-members engaged in paid activity, 31% are freelance, which indicates a certain level of financial precariousness, an interpretation that is validated by FGD data. 22% are employed in the service sector and in sales, 11% are state employees and 9% have specialised jobs like lawyer, judge and engineer.

47

55+ yrs

41%

36-55 yrs

62%

26-35 yrs

38%

57%

18-25 yrs 14-17 yrs

59%

43%

30%

70%

2%

98%

0-13 yrs

100% Yes

No

Table 3.16: Lebanese HH-members engaged in paid activity by age

Agriculture worker Doctors, nurses, health staff

2% 2% 2% 4% 5% 6%

Machine operator Educators Technicians and specialised assistants Handicrafter Specialised (lawyers, judges, engineers, scientists…) State employee (includes army, ISF)

9% 11% 22%

Service workers and sales in shops

31%

Freelance

Table 3.17: Types of paid activity Lebanese HH-members are engaged in

Disabilities The proportion of HH-members in the Lebanese domain who reportedly have a disability is relatively small. The highest proportion of disabilities, 4%, was reported for the eldest age group of 55 years and older. Of HH-members reported have a disability, around 60% have physical disabilities (motor, hearing and seeing) and around 20% have intellectual disabilities. Learning difficulties constitute around 10% of the total and combined disabilities 5%. Only 25% of individuals with disabilities were reported to have a caregiver to support them; 73% do not. When asked whether Lebanese HH-members with disabilities had received a disability card by MOSA, the Bekaa and South mohafazat score the best: 100% and 67% respectively responded affirmatively to the question. Akkar and Nabatieh score the lowest with only 35% having received a disability card by MOSA. In Beirut, Mount Lebanon, the North and Baalbek-Hermel, around half of Lebanese HHmembers with disabilities had received a MOSA disability card.

48

South

67%

North

33%

55%

Mount Lebanon

45%

50%

El Nabatieh

47%

36%

64%

Bekaa

100%

Beirut

55%

Baalbek-El Hermel

56%

Akkar

3%

35%

27%

18% 41%

Yes

No

DK

3%

65%

Table 3.18: Lebanese HH-members with disabilities who have received a disability card from the Ministry of Social Affairs

3.3. Characteristics of HHs: Syrians registered with UNHCR domain Respondents profile and HH composition Of Syrian respondents registered with UNHCR, 94% are female and 6% male. Of all domains, the registered Syrian domain has the highest rate of female-headed HHs at 15%, compared to 85% maleheaded HHs. Of the 94% female respondents, 65% are 18-35 years, whereas, of the 6% of male respondents, 80% belong to the same age bracket. Of the 85% male-headed HHs, the heads of HHs are relatively young, with 43% being 18-35 years and 51% aged 36-55 years. A similar trend can be noted for female heads of HHs, with 40% of them between 18 and 35 years and almost 50% of them being 36-55 years.

56 yrs and over

36-55 yrs

6%

12%

51%

Female

48%

Male 18-35 yrs 100%

43% 50%

40% 0%

50%

100%

Table 3.19: Subset percentage of Syrian HH-heads registered with UNHCR by gender On a mohafaza level, the highest percentage of female interview respondents in the registered Syrians domain, 100%, was in Beirut, closely followed by the South at 96% and Bekaa. In contrast, the two highest percentages of male interview respondents are in North at 11% and in Mount Lebanon at 6%. On the gender of HH-heads, the highest percentage of male-headed HHs or 93% was found in Beirut, followed by Mount Lebanon and the South at 87%. Bekaa (including Baalbek-Hermel) and North (including Akkar) have the highest percentage of female-headed HHs at 17%.

49

HH population by gender, age and marital status The total of 1,211 Syrian HHs registered with UNHCR successfully interviewed for the KAP Study were composed of 7,096 persons; 3,619 are female, representing 51% of the domain, while 3,477 are male, representing 49%. For several mohafazat, around half of the HHs in the registered Syrians domain consist of 6 persons or more. The highest proportion of HHs with 6 persons or more was found in Nabatieh (64%), followed by Bekaa (56%) and Baalbek-Hermel (52%). Registered Syrian HHs in Beirut are comparatively the smallest, with almost 60% of them comprising no more than 4-5 members per HH.

South

7%

43%

North

14%

Mount Lebanon

14%

El Nabatieh Bekaa Beirut Baalbek-El Hermel Akkar

50%

31%

55%

43%

16%

44%

20%

12%

64%

32%

56%

20%

57%

17%

23%

31%

12%

52%

40% 2-3

49%

4-5

6 and more

Table 3.20: Number of Syrian HH-members registered with UNHCR by mohafaza The age structure for the registered Syrian domain indicates a young population and a high fertility rate. Children between 0 and 17 years constitute 55% of the total number of family members. Around 30% of registered Syrian HH-members are 18-35 years old and 15% are 36-55.

4% 15%

47% 15%

12% 8% 0-13 years

14-17 years

18-25 years

26-35 years

36-55 years

55+ years

Table 3.21: Age of all HH-members for the domain of Syrians registered with UNHCR Furthermore, 90% of registered Syrians children under 18 years live in the same HH as their biological parents, while 8% live in the same HH as the mother and without the father. A small fraction of registered Syrian children, 2%, does not live with their biological parents but instead lives with other caregivers. Around 50% of 18-25-year-old registered Syrian HH-members are married; while 90% of

50 the higher age groups of 26-35 and 36-55 years are married. One can note that a relatively high rate, almost 40%, of registered Syrian HH-members of 55 years and older are widowed.

58% Female

1% 1% 5% 35% 66%

Male 33% Not married

Separated

Divorced

Widowed

Married

Table 3.22: Marital status of HH-members in the domain of Syrians registered with UNHCR Educational level of respondents Educational attainment results among the registered Syrian domain contain some gender differences. For instance, while 12% of all male respondents have never been to school, the number for female respondents is 18%. While 47% of male respondents’ highest completed educational level is primary education, for female respondents it is 37%. For both male and female respondents, the percentage of those who have completed university as highest educational level is only 4%. The highest level of educational attainment in the registered Syrians domain was found in Nabatieh, where 26% of survey respondents completed secondary and university education, followed by the North and Beirut at 17%. The highest proportion of registered Syrian respondents who have never attended school is in Baalbek-Hermel at 41%, followed by Bekaa at 19%. Overall, Baalbek-Hermel has the lowest educational attainment numbers, followed by the Bekaa and South. South North

6%

63%

11% 1%

Mount Lebanon

5% 1%

El Nabatieh

14%

Bekaa

35%

32%

13% 1%4% 9%1% 1%5% 22%

45%

26%

50% 41%

11% 1%

6%2%

32%

26%

Beirut 3% 3%

Akkar

35%

46%

19%

Baalbek-El Hermel

23%

23%

7%% 3% 7% 3% 10%

39% 34%

2%4%

15%

39%

5%

7% 3%5%


Preschool

Primary (cycle 1&2)


Secondary

BP

BT, TS or LT

University

51

Table 3.23: Highest level of educational attainment of Syrian respondents registered with UNHCR by mohafaza Housing characteristics Registered Syrian HHs interviewed for the KAP Study survey reside in four types of housing: 38% live in purpose-built apartments, 35% live in purpose-built houses, 20% live in formal settlements and 7% live in substandard buildings. Most registered Syrian HHs, 90%, live with their families alone and 9% live with Syrian relatives. From the total HHs interviewed, 55% have two rooms and 23% have three or more rooms and the same number has one room. HH population’s engagement in paid activity Of the total number of Syrian HH-members, 36% of age category 26-35 years and 35% of age category 36-55 years are engaged in paid activity. Of those HH-members who do work, 45% are freelance, which indicates a high degree of financial precariousness. Among the four domains, registered Syrians have the highest proportion of HH-members working as freelancers. Qualitative data also indicate that Syrian men often are day labourers, with everything that this entails of insecurity and precariousness.

55+ yrs

6%

94%

36-55 yrs

35%

65%

26-35 yrs

36%

64%

18-25 yrs 14-17 yrs

21%

79%

7%

93%

0-13 yrs

100% Yes

No

Table 3.24: Syrian HH-members registered with UNHCR engaged in paid activity by age

Technicians and specialised assistants Educators

2% 2% 2% 3%

Primary profession Cleric Service workers and sales in shops

10%

Agriculture worker

14% 20%

Handicrafter

45%

Freelance

Table 3.25: Types of paid activity Syrian refugee HH-members registered with UNHCR are engaged in

52

Disabilities The proportion of HH-members for registered Syrians who are reported to have a disability is relatively small. This might indicate a confusion of categories and uncertainty as to what constitutes a disability among registered Syrian respondents. The highest proportion of disabilities, 7%, is reported for the eldest age group of 55 years and over. Of those HH-members reported to have a disability, around 72% are identified as physical disabilities (motor, hearing and seeing) and around 20% as intellectual disabilities. Learning difficulties constitute around 1% and combined disabilities 5%. Only 20% of registered Syrians with disabilities are reported to have a caregiver to support them, almost 80% do not.

3.4. Characteristics of HHs: Syrians in ISs domain Respondents profile and HH composition Respondents in the Syrian in ISs domain are to 98% female and only 2% male, constituting the highest female response rate per domain. Syrians in ISs had the second highest rate of female-headed HHs at 14%, compared to 86% male-headed HHs. All male respondents are in the 18-25 years age bracket. Female respondents are evenly distributed among all age groups with slightly more 26-35 years olds. Syrians in ISs have the highest proportion of male and female heads of HHs in the youngest age bracket of 18-25 years. Male heads of HHs, who constitute the majority, are relatively young. While 44% are 18-25 years, around 50% are 36-55 years old.

56 yrs and over

36-55 yrs

8%

8%

49%

Female

40%

Male 18-35 yrs

100%

44% 50%

53% 0%

50%

100%

Table 3.26: Subset percentage of Syrian in ISs HH-heads by gender HH population by gender, age and marital status The total of 281 Syrian HHs in ISs successfully interviewed for the KAP Study is composed of 1,583 persons; 823 are female, representing 52% of the domain, while 760 are male, representing 48%. The Syrians in ISs domain has proportionally the youngest population: 61% of HH-members are 0-17 years, 23% are 18-35 years and just 16% are older than 36 years.

53

2% 14%

12% 51% 11% 10% 0-13 years

14-17 years

18-25 years

26-35 years

36-55 years

55+ years

Table 3.27: Age of all HH-members for the Syrians in ISs domain Given the young population, over half of the Syrian HH-members in ISs are not married. Slightly more male (67%) than female (64%) HH-members are not married. 33% of both male and female HHmembers are married and 3% of female HH-members are divorced. As many as 64% of HH-members in the Syrian in ISs domain that belong to the age group 18-25 years are married.

55+ yrs

66%

29%

5%

36-55 yrs

94%

4% 3%

26-35 yrs

93%

4% 4%

18-25 yrs 14-17 yrs

64% 2%

36% 98%

0-13 yrs

100% Married

Widowed

Not married

Table 3.28: Marital status of HH-members in the Syrians in ISs domain by age Similar to data from the registered Syrian domain, there is an indication of child marriage as 2% of children between 14-17 years are married. Moreover, Syrians in ISs have a comparatively higher rate of widowed HH-members than other domains. The biological parents are living in the same HH as 90% of all HH-members under 18 years, while 8% of children live only with their biological mother and 2% do not live with their biological parents, meaning that they are looked after by other caregivers.

54

63% Female

3% 32% 67%

Male

33% Not married

Widowed

Married

Table 3.29: Marital status of HH-members in the Syrians in ISs domain by gender Educational level of respondents In comparison to the other domains, Syrians in ISs have the highest proportion of respondents who have never attended school. The proportion is slightly higher for female than male, at 34% compared to 30%. Similarly, more men than women have completed primary education: 43% for male and 34% for female respondents. Overall, the level of education is low as most have dropped out of school before reaching secondary education.

Female

Male

34%

1%

30%

34%

43%

23%

20%

6% 1%

5% 2%


Preschool

Primary (cycle 1&2)


Secondary

University

Table 3.30: Highest educational level completed by Syrian respondents in ISs by gender Housing characteristics Syrian HHs in ISs surveyed for the KAP Study all reside in informal settlements. Most HHs, 89%, live with their families alone, 10% of HHs live with Syrian relatives and 1% with Lebanese relatives. The make-up of ISs and the available facilities vary from one IS to the other. Generally, the same family tends to share one tent, which is why no differentiations are made regarding the number of rooms. HH population’s engagement in paid activity 36% of HH-members belonging to the 18-25 age group are engaged in paid activity, compared to 43% of the 26-35 age group and 38% of the 35-55 age group. Of all domains, Syrians in ISs have the highest proportion of children of the ages 14-17 years who are engaged in paid activity. Regarding types of paid activities, 36% are freelancers, 28% work in agriculture and 18% are handcrafters.

55

55+ yrs

5%

36-55 yrs

38%

26-35 yrs

0-13 yrs

62%

43%

18-25 yrs 14-17 yrs

95%

57%

36%

64%

14%

86%

2%

98% Yes No

Table 3.31: Syrians in ISs HH-members engaged in paid activity by age Disabilities The proportion of HH-members in the Syrians in ISs domain who are reported to have a disability is relatively small. This might indicate a confusion of categories and uncertainty as to what constitutes a disability among Syrian respondents in ISs. The highest proportion of disabilities, 5%, was reported for the eldest age group of 55 years and over. Of those HH-members who were reported to have a disability, around 70% are identified as physical disabilities (motor, hearing and seeing) and around 22% as intellectual disabilities. Syrians in ISs have the highest proportion of HH-members with disabilities. Only 17% of Syrians in ISs with disabilities are reported to have a caregiver to support them.

3.5. Characteristics of HHs: Palestine refugees’ domain Respondents profile and HH composition Palestine refugee survey respondents are to 88% female and 12% male, constituting the highest maleresponse rate of any domain. Male-headed HHs constitute 87% of all Palestine refugee HHs, while female-headed HHs constitute 13%. Of the 12% male respondents, over half are 18-25 years old, while a third are 26-35 years old. Around half of female Palestine refugee respondents are 36-55 years, around a third are aged 26-35. The most common age-bracket for both male and female heads of HHs is 36-55 years. While around 30% of male Palestine refugee HH-heads are 18-35 years old, 20% of female HH-heads are in that age bracket.

56 yrs and over

36-55 yrs

13%

11%

60%

Female

69%

Male 18-35 yrs 100%

27% 50%

20% 0%

50%

Table 3.32: Subset percentage of Palestine refugee HH-heads by gender

100%

56 HH population by gender, age and marital status The total of 408 Palestine refugee HHs successfully interviewed for the KAP Study is composed of 2,142 persons, of whom half, or 1,071 individuals, are female and half are male. In terms of age structure, Palestine refugee HHs resemble Lebanese HHs: 43% of HH-members are 0-17 years old, around 30% are 18-35 and 26% are over 36 years old.

4% 22%

33%

16% 10% 15% 0-13 years

14-17 years

18-25 years

26-35 years

36-55 years

55+ years

Table 3.33: Age of all HH-members for the Palestine refugee domain Around 60% of male and female HH-members are not married, compared to around 40% of HHmembers who are married. The majority of HH-members aged 26 years and older are married. Around 20% of HH-members aged 18-25 years are married. Out of all children under 18 years age, 6% live in the same HH as their biological mother without their biological father, while 93% live in the same HH as both biological parents.

55+ yrs

80%

36-55 yrs

95%

26-35 yrs 18-25 yrs

15%

3% 2%

81%

1%

18%

5%

18%

82%

14-17 yrs

100%

0-13 yrs

100% Married

Widowed

Not married

Table 3.34: Marital status of HH-members in the Palestine refugees’ domain by age

57

67% Female

33% 62% Male

1% 19% 37% Not married

Engaged

Widowed

Married

Table 3.35: Marital status of HH-members for Palestine refugees’ domain by gender Educational level of respondents The levels of completed education among Palestine refugee respondents point towards gender differences: while female respondents perform better in primary and complementary education, male respondents perform slightly better from secondary education onwards. Interestingly, only 3% of female respondents have never been to school.

Female

3%

Male

24%

46%

34%

Never been to school Secondary University

27% Primary (cycle 1&2) BP

11% 1%4% 10%

13%

5% 5%

16%

Complementary (cycle 3) BT, TS or LT

Table 3.36: Highest educational level completed by Palestine refugee respondents by gender Housing characteristics Palestine refugee HHs surveyed for the KAP Study reside in four different types of housing arrangements: almost 60% live in purpose-built apartments, 30% in purpose-built houses and the other 10% live in formal settlements and purpose-built villas. Almost all interviewed Palestine refugee HHs live with their families alone, only 3% of HHs live with Palestine refugee and Lebanese relatives. Around 66% of Palestine refugee HHs have three rooms or more in their home; 31% have two rooms and 3% have only one room. HH population’s engagement in paid activity In comparison to other domains, Palestine refugee HH-members have the highest proportion (49%) of HH-members belonging to the 55 and older age group engaged in paid activity. 24% of HH-members aged 18-25 years are engaged in paid activity, compared to 43% of those belonging to the 26-35 age

58 group and 49% in the 36-55 age bracket. In terms of types of paid activities, 33% of working Palestine refugee HH-members are engaged in handicraft, 23% as service workers and in sales jobs and 16% as freelancers.

55+ yrs

49%

51%

36-55 yrs

49%

51%

26-35 yrs

43%

18-25 yrs 14-17 yrs 0-13 yrs

57%

24% 4%

76% 96% 100% Yes No

Table 3.37: Palestine refugee HH-members engaged in paid activity by age Disabilities The proportion of HH-members for Palestine refugees who are reported to have a disability is relatively small. This might indicate a confusion of categories and uncertainty as to what constitutes a disability among Palestine refugee respondents. The highest proportion of disabilities, 4%, was reported for the age group of 36-55 years, followed by the age group of 14-17 years at 3%. Of those HH-members who reportedly have a disability, around 71% are identified as physical disabilities (motor, hearing and seeing) and around 14% as intellectual disabilities. Palestine refugees have the highest proportion of HH-members with combined disabilities at 10%. Furthermore, around 30% of Palestine refugees with disabilities are reported to have a caregiver to support them, with 65% having no one to rely on for support.

59

4. HEALTH Improving the health of children is among UNICEF's core objectives worldwide. “Healthy children become healthy adults: people who create better lives for themselves, their communities and their countries.”8 UNICEF collaborates with governments and nongovernmental organisations at national, regional and community levels, with a focus on supporting the health of both children and women. Child survival is a predominant objective. Exclusive breastfeeding, proper nutrition and vaccination are important means to achieving this.

4.1. Situation analysis 4.1.1. Health – sector response The overall health response in Lebanon focuses on improving • • • • •

Access to primary healthcare services Secondary and tertiary care Access to hospitalisation Outbreak control Healthcare for children, adolescents and youth

More than 2.4 million persons are in need of health support, of whom more than 1.5 million are targeted.9 The child health response concentrates on three key issues: addressing malnutrition, promoting exclusive breastfeeding, and optimizing vaccination coverage.10 This KAP Study focuses on the latter two subjects and assesses caregivers’ attitudes towards exclusive breastfeeding alongside their knowledge of their children’s vaccination calendar.

4.1.2. Baseline indicators Caregivers’ attitudes towards exclusive breastfeeding In order to gain better insight into caregivers’ disposition towards breastfeeding, the first indicator assessed under the situation analysis for health is the percentage of caretakers with positive attitudes towards exclusive breastfeeding. Optimal breastfeeding of infants under two years of age has the greatest potential impact on child survival of all preventive interventions 11

8

UNICEFb 2017.

9

Government of Lebanon, and United Nations 2017.

10

Ibid: 90.

11

UNICEFb 2017.

60 Breastfeeding “has profound impact on a child’s survival, health, nutrition and development. Breast milk provides all of the nutrients, vitamins and minerals an infant needs for growth for the first six months, and no other liquids or food are needed. In addition, breast milk carries antibodies from the mother that help combat disease. The act of breastfeeding itself stimulates proper growth of the mouth and jaw, and secretion of hormones for digestion and satiety. Breastfeeding creates a special bond between mother and baby and the interaction between the mother and child during breastfeeding has positive repercussions for life, in terms of stimulation, behaviour, speech, sense of wellbeing and security and how the child relates to other people. Breastfeeding also lowers the risk of chronic conditions later in life, such as obesity, high cholesterol, high blood pressure, diabetes, childhood asthma and childhood leukaemia. Studies have shown that breastfed infants do better on intelligence and behaviour tests into adulthood than formula-fed babies”.12

For these reasons, UNICEF and partners promote exclusive breastfeeding during the first six months of life. ‘Exclusive’ is to be understood as not consuming water or other fluids or food to supplement breastmilk, with the exception of oral rehydration solution, vitamins, mineral supplements, and medication. UNICEF’s 2016 household baseline survey in Lebanon shows that the rate of exclusive breastfeeding during the first six months is highest among Syrian mothers at 33.5% followed by Lebanese at 24.8% and Palestine refugees (26.2% for PRL and 21.2% for PRS) women. A 2016 country-wide vulnerability assessment of Syrian refugees (VaSyr) found large regional discrepancies in breastfeeding practices for children under 6 months with Zgharta having the highest percentage of breastfed Syrian refugee children at 70% and Hermel the lowest at 30%.13 The UNICEF 2016 baseline survey underlines the need to promote exclusive breastfeeding across population domains. In order to do so in an effective manner, an understanding of prevailing attitudes towards breastfeeding is essential. The current KAP Study therefore gives insight into prevailing attitudes towards breastfeeding and appropriate infant and young child feeding or IYCF practices among caregivers across domains. A number of earlier studies already gave partial insight into attitudes among certain population groups. •

•

For the Lebanese domain, reasons listed for the discontinuation of breastfeeding include insufficient milk, fear of weight gain or breast sagging, pain, sleep deprivation, exhaustion, or maternal employment.14 Cultural beliefs can also inform caregivers’ decision to opt for bottle feeding, for instance the belief in an inherited inability to produce milk, in having ‘bad milk’, or in the transmission of abdominal cramps to infants through breast milk.15 For the Syrian domain, IMC identified key determinants of breastfeeding behaviour based on research among 45 breastfeeding (‘doers’) and 45 non-breastfeeding (‘non-

12

UNICEFa 2017; see also WHOa 2017.

13

UNHCR, UNICEF, and WFP 2016.

14

Nabulsi 2011.

15

Osman, El Zein and Wick 2009.

61

•

doers’) mothers in Lebanon. The report lists four determinants that were most prominently observed among Syrian refugee women in Lebanon: - First, women’s perceived self-efficacy determines whether women find it easy or difficult to exclusively breastfeed. Drivers of exclusive breastfeeding among doers include bonding or positive feelings as well as economic savings. Nondoers acknowledge the benefits for maternal health and their baby’s nutritional status, yet they are unable to exclusively breastfeed due to a sick or hospitalised baby, poor maternal health and nutritional status, or stress and crowding. - The second and third determinants relate to perceived positive and negative consequences of exclusive breastfeeding. Doers identify diarrhoea prevention, increased immunity, and disease prevention as drivers of breastfeeding, while non-doers – especially those in informal settlements – mention saving money as an advantage of exclusive breastfeeding. Doers did not relate any potential disadvantages, while non-doers – particularly women residing in informal settlements - perceive transmission of diseases from mother to child, as well as depletion of maternal nutrients and health, as disadvantages of exclusive breastfeeding. - The fourth and last determinant relates to perceived social norms. Doers identify the approval of their father-in-law, father, and mother-in-law as drivers of exclusive breastfeeding, while non-doers attribute barriers to exclusive breastfeeding predominantly to their husbands.16 Data on attitudes towards breastfeeding among Palestine refugee caregivers residing in camps in Lebanon could not be located for the situation analysis.

Caregivers’ knowledge on vaccination under 1 year of age To obtain thorough understanding of caregivers’ knowledge of vaccination calendars for their children, the situation analysis of another health indicator is the percentage of caretakers of children aged 0-1 year who know that children need to be brought to the health facility six times to complete all the recommended vaccinations before their first birthday. Immunization is one of the most successful and cost-effective public health investments we can make for future generations 17 Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. Immunization is a proven tool for controlling and eliminating lifethreatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with

16

Perera and Reese Masterson 2016.

17

UNICEF 2017c.

62 proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.18

Overall, vaccination coverage in Lebanon is high, but variances are observed across cazas (administrative districts).19 WHO and UNICEF estimates and Government of Lebanon figures for vaccination coverage in 2016 are as follows:20 Vaccine WHO/UNICEF estimate Govt. of Lebanon figure DTP1

84%

92%

DTP3

81%

90%

Pol3

75%

90%

IPV1

84%

90%

MCV1

79%

90%

MCV2

75%

71%

RCV1

75%

NA

HepB

94%

100%

HepB3

81%

90%

Hib3

81%

90%

Table 4.1: WHO and UNICEF, Estimates of Immunization Coverage in Lebanon (2016)

Considering the adverse living conditions in informal shelters and camps, there are heightened risks of outbreaks of vaccine-preventable diseases and the spread of such diseases to host communities. The highest outbreak rates of vaccine-preventable diseases have been observed in the mohafazat of Mount Lebanon, Bekaa and South. It is likely that not all outbreaks have been reported.21 Lebanon’s Ministry of Public Health reports high numbers of children benefitting from free routine vaccinations through its Primary Healthcare Centres, hereafter PHCs.22 •

Syrian refugee households were found to face several barriers in accessing free vaccinations, including a lack of awareness of whether a child had received vaccinations or not at 10.2%, distance to vaccination location at 7.8%, or claiming that vaccinations were not available at 4.9%. 59.1% of Syrian refugee households reported no difficulties in accessing immunization services.23 UNHCR lists the following barriers that prevent Syrian caregivers from accessing a vaccine for their children:

18

WHOb 2017.

19

Government of Lebanon, and United Nations 2017: 90.

20

WHO and UNICEF 2016. Please note that these data are not disaggregated by population domain.

21


22

Ibid.

23

Lyles and Doocy 2015: 58-59. Note that respondents to this study were selected on the basis of having children between 12 and 23 months, which does not correspond to the 0-12 month age bracket used and referred to in this study.

63

•

•

- Long wait (33.3%) - Not knowing where to go (25.9%) - Unable to afford the fees (11.1%) - Distance (7.4%) - Unable to afford transportation (7.4)24 Lebanese and Syrian caregivers commonly take their children to PHCs for vaccinations, 15% and 21% respectively. Reliance on vaccination campaigns varies as well, with 16% of Syrian refugee families relying on campaigns and only 4% of Lebanese families.25 A report by UNICEF, OCHA and REACH (2015) attributes this difference to lower knowledge of immunization services among refugee populations.26 39.1% of Syrian caregivers reported lack of knowledge as reason for not vaccinating their children.27 UNHCR found that 71% of Syrian refugees know that children can access free vaccinations at PHCs.28 No information was found on Palestine refugee caregivers’ knowledge or practices in relation to accessing immunization programmes.

4.2. Qualitative findings overview 4.2.1. Supply and demand of services The focus of the health indicators used for this study is child survival. A crucial factor is to what extent the supply of services that increase the chance of child survival matches the demand for those services. To optimize the correspondence of supply and demand, both supply and demand need to be monitored and managed. PHCs Important suppliers of health services are the country’s, at the time of writing, 204 PHCs. They offer essential services in fields like paediatrics, including vaccination and nutrition services, reproductive health and chronic disease. All PHCs are similar in structure and have at least five clinics, at least one nurse, one IT specialist and one or more doctors. PHCs are contracted by MOPH, but just five are currently the property of MOPH. The rest is privately owned. PHCs are usually affiliated with NGOs (67% of PHCs), municipalities (26%) or public organizations like MOSA (13%). MOPH has an accreditation programme for PHCs, part of which is an evaluation of PHCs’ outreach capacity. Outreach involves forming a community committee, chaired by influential people from the community (mayors, municipal directors, priests, sheikhs and so on), which serves as a consultation mechanism for the PHC. At the time of writing, 75 PHCs are accredited. In addition, MOPH has six field coordinators who make announced and unannounced visits to PHCs on a monthly schedule, filling in checklists on their tablets. A major challenge for PHCs is a lack of trust in 24

UNHCR 2016.

25

UNICEF, OCHA, and REACH 2015.

26

Ibid.

27

UNICEFe. 2017: 12.

28

UNHCR 2016.

64 their capacity. Over the years, and in particular since the beginning of the Syria crisis, a common perception was that PHCs are for poor people and that the quality of their service is inferior to private health care providers. KAP Study qualitative data indicate, however, that this is too simple a picture as the capacity of PHCs and the quality of their service varies. MOSA/SDCs Another supplier of health services is Lebanon’s Social Development Centres or SDCs, of which there currently are 228. They sort under MOSA. SDCs provide health services such as paediatrics, gynaecology, heart and lung monitoring, vaccination, dental care, and screening for malnutrition. The range of health services offered varies among SDCs. Because SDCs’ principal responsibility is to provide social services, their clients tend to have low incomes. UNRWA Access to primary health care for Palestine refugees is provided free of charge by UNRWA operating 27 primary healthcare facilities, providing around 930,000 general consultations and over 23,000 dental screening consultations per year. In Lebanon, UNRWA has formed an arrangement with Palestine Red Crescent Society hospitals to guarantee equity for Palestine refugees in access to secondary health care. In all other fields, a reimbursement scheme is in place for secondary and tertiary care provided by Lebanese healthcare centres and hospitals, to which Palestine refugees can get referred to.

4.2.2. FGDs summary Beirut

Mount Lebanon

Akkar

North

Bekaa

BaalbekHermel

South

Nabatieh

Syrian mothers

Syrian fathers

Lebanese mothers

Palestine refugee mothers

Lebanese mothers

Syrian mothers

Palestine refugee fathers

Lebanese fathers

Table 4.2: Health FGDs matrix Data from the FGDs show that there is a clear gender division when it comes to children’s health. Female caregivers are responsible for, and often the primary decision-makers on, breastfeeding and vaccination of children. In some cases, female caregivers depend on their husbands for accompaniment to the health centres, especially in the Syrian domains. Overall, men and women believe breastfeeding and vaccinations to be important and necessary. No strong attitudes against either could be noted among any population group, although the responsibility for both was clearly placed on the mother. Women had generally more knowledge than men on the usefulness of both breastfeeding and vaccinations. Female caregivers in the FGDs showed more knowledge on the topic of vaccination than men, including on vaccination frequency and on its health benefits. While all population groups had a positive attitude towards vaccination, it is worth noting that male caretakers had little or no information about their children’s vaccination history. In practice, for Syrians and PRS financial barriers exist to getting children vaccinated as respondents mentioned needing to pay a fee at health centres. Moreover, reported protection challenges among female Syrian respondents indicate that women sometimes rely on their husbands to leave their homes, who work long hours and therefore not prioritise taking the child for vaccination.

65 “My daughter is still too young for vaccines. She needs to be at least one year old” – Syrian man, FGD in Mount Lebanon, May 2017 Across all domains, attitudes towards breastfeeding are positive. The most positive attitudes in the qualitative findings can be noted among male and female Syrian respondents, followed by Palestine refugees and Lebanese respondents. While breastfeeding was stated to provide children with the needed nutrition and for being beneficial for the child’s health, this opinion seems to be mostly based on relatives’ advice and common practice, rather than evidence-based knowledge on the topic. Exclusive breastfeeding is not common practice in any domain; supplementary feeding of water mixed with sugar and traditional remedies are practiced across the board. Syrians seem to be increasingly drawn towards formula milk as a result of prescriptions after delivery in Lebanese hospitals. “I cannot afford to pay $100 for one vaccination when I have 3 children. The PHC is more cost-effective and the same doctor from the private clinic works there.” Lebanese mother, FGD in Bekaa, June 2017 Overall, the main barrier to accessing healthcare services is financial. While most respondents mentioned accessing PHCs, dispensaries or UNRWA clinics (for Palestine refugees), these services are not completely free of charge. In this respect, displaced Syrians and PRS seem to present the most vulnerable group. Syrians often find it difficult to pay consultation fees and are aware that they do not always need to do so, for instance for vaccinating a child. On the other hand, Lebanese respondents seem to have more healthcare options to choose from and seem to be more able to pay a fee for PHC uptake. Lebanese respondents in FGDs were aware of the cost-breakdown of the PHC fees. Many mentioned finding PHCs increasingly appealing because of the cheaper cost, good quality of vaccines and basic services as well as the availability of doctors who when not working at the PHC work at private clinics. Lebanese respondents perceived that while PHCs offer cheap yet good quality vaccine, the private clinic provides a more thorough examination of the child. “UNWRA follows up on vaccination and that is very important” – Palestine refugee woman, FGD in North, May 2017 Palestine refugee respondents were the most satisfied with UNRWA’s basic healthcare services, especially when it comes to vaccination, all of which is free of charge. While UNRWA’s services are completely free of charge, secondary and tertiary healthcare is often only partially covered by UNRWA. Palestine refugee respondents mentioned facing financial challenges when needing specialised medical services (such as for chronic diseases). Some knowledge gap exists in relation to what costs UNRWA can cover, for instance in relation to hospital services. While Lebanese and Palestine refugee respondents seem to have a one-stop healthcare solution, namely private clinics, PHCs and UNRWA clinics, many Syrians describe passing multiple stops until they receive the service they need. Some male PRS respondents who have arrived recently to Lebanon were not sure whether UNRWA provided healthcare services to those living outside the designated camps. “I took my son for vaccination thinking they are for free and already had a checkup a day before in the MSF clinic, but [the nurse] refused and obliged me to see a doctor, charged LL 20,000 to enter and refused to give my son the vaccination. I then went to MSF for a paper to send to the clinic but they said that they are not allowed to give a report” – Syrian woman, FGD in Baalbek-Hermel, June 2017 In terms of medical staff, all nationality groups trust doctors the most and prefer to receive healthcare services by them. Palestine refugee respondents also highly trust nurses in UNRWA clinics, as they believe they have received good training and take more time to check patients, unlike doctors who seem to pay less attention to individual patients. Lebanese respondents across the country do not fully

66 trust nurses and mentioned that doctors spend less time with individual patients in PHCs than in private clinics. While Syrian respondents generally also prefer to be treated by doctors, they mention not having much choice in deciding which medical professional treats them. While Syrian respondents often avoid regular check-ups due to financial difficulties, Palestine refugee respondents avoid seeking specialised medical treatment for financial reasons.

4.3. Baseline indicators: Health 4.3.1. All domains Knowledge on vaccination under 1 year of age An overwhelming majority of caretakers (97-100%) in all domains know that children aged 0-1 year need to be vaccinated. 64% of caretakers know that children need to be brought to the health facility at least 6 times to complete all the recommended vaccines by the child’s first birthday. Most respondents either over- or underestimate the number of required vaccination sessions.

% of respondents who know that children need to be brought to the health facility at least 6 times to complete the recommended vaccines by the child’s first birthday

Lebanese residents

Syrians registered with UNHCR

Syrians living in ISs


Male

61%

52%

57%

49%

Female

73%

59%

55%

38%

Total

69%

55%

55%

42%

Total

64%

Table 4.3: Overview of health indicator on vaccination by domain, gender and in total Practice of antenatal care and child delivery Lebanese residents




Total

% of female respondents with at least one child who visited antenatal care for the last child delivered

94%

87%

91%

87%

92%

% of female respondents with at least one child who visited antenatal care for the last child delivered four times and more

90%

64%

63%

74%

84%

% of mothers in the households who

96%

88%

79%

97%

94%

67 delivered their last child in the hospital

Table 4.4: Overview of health indicators on antenatal care and child delivery When respondents were asked who paid for the mother’s delivery for the last child, around 50% of total respondents stated to have paid for the delivery themselves. Critically, some respondents chose several options as they combined different payment methods. A more detail breakdown of the different domains is presented in the sections below.

Self

51%

National Social Security Fund

19%

MOPH

11%

Private insurance

10%

NGO/UN (including UNRWA)

8%

UNHCR

7%

Fund of the army

5%

Fund of the Internal Security Forces

1%

Donate from friends or relatives

1%

Cooperative of civil Servants

1%

Table 4.5: Results of total respondents when asked who paid for the mother’s delivery of the last child in the household

Attitude on exclusive breastfeeding 96% of caretakers have a positive attitude towards exclusive breastfeeding. In this study, exclusive breastfeeding is defined as giving the child only breastmilk without addition of anything (not water, tea or other fluids and no solids) and is recommended until the child has reached 6 months of age. 95% of respondents state that exclusive breastfeeding provides good health for the child. Around 30% state that they have seen good results from others and 18% state that it was recommended by relatives, while 15% state that it was recommended by a doctor or nurse. When asked about breastfeeding in general, 50% of respondents believe it is important to breastfeed until 24 months, while 34% believe until 12 months. When asked why mothers do not breastfeed or stop breastfeeding, and given the option to provide multiple responses, 61% state it is due to a lack of milk, 24% that the baby is hungry and needs more food and 34% that it is time to stop breastfeeding.

% of respondents who believe in exclusive breastfeeding

Lebanese residents




Male

95%

94%

95%

95%

Female

96%

97%

99%

99%

Total

68

% of respondents who believe it is important to breastfeed until 24 months

Total

95%

96%

99%

97%

Male

41%

63%

79%

59%

Female

46%

65%

86%

48%

Total

44%

64%

85%

53%

96%

50%

Table 4.6: Overview of health indicators on breastfeeding by domain, gender and in total

4.3.2. Lebanese domain Knowledge on vaccination under 1 year of age 69% of Lebanese caretakers know that children need to be brought to the health facility at least 6 times to complete all the recommended vaccines by the child’s first birthday. 16% in the Lebanese domain think that less than six vaccination sessions are needed.

2% 6% 8% 14% 21% 48% 3

4

5

DK

6

Above 6

Table 4.7: Results of Lebanese caretakers being asked how many vaccination sessions children of the age of one year need to have completed Data on vaccination practice were cross-tabulated with gender to investigate whether female and male respondents differ in their awareness of where to go for vaccinations. Other than that, the data on where Lebanese turn for vaccinations is an indication of the demand for this particular service, although demand is also shaped by the availability and supply of services. As can be gleaned from the table below, PHCs, dispensaries and private clinics are by far the most common suppliers of vaccinations in the Lebanese domain. Male Lebanese respondents appear to overestimate or exaggerate the role of private clinics and private hospitals as dispensaries of vaccinations, which indicates a lack of knowledge on the practice as qualitative data show that it is mostly women who see to it that children are vaccinated.

69

Female

1% 4% 1% 4%

DK Not applicable

38%

1%

Male

Public hospital

50%

2% 3% 2% 6%

Private hospital Private clinic MOSA clinic

49%

1%

PHC or dispensary supported by UN/NGOs

38%

Table 4.8: Results by gender of Lebanese respondents being asked where they usually go to receive a vaccination for their child “I find it more reassuring for the doctor to vaccinate.” Lebanese father, Nabatieh, June 2017 When asked for the primary reason for not going to a PHC for vaccination, almost half of respondents in the Lebanese domain or 42% said that they consider the quality of PHCs to be not good enough. Also, around a quarter of respondents do not trust PHC vaccines and are discouraged by family members and friends to visit PHCs for vaccination. However, qualitative data nuances this finding as Lebanese respondents are increasingly aware of PHC services, including vaccination, available there. Lebanese respondents from FGDs in Bekaa, Akkar and Nabatieh stated to increasingly make use of the PHCs and to trust the vaccination service there. Lack of knowledge about available health centres/ UNRWA clinic Family member or friend advised against it Unfriendly staff/environment

7% 11% 6% 4% 6%

No transportation Too expensive to get to clinic Vaccinator not available at clinic

9% 5% 4%

Do not have enough money to vaccinate Vaccination too expensive

20% 14% 42%

Do not trust vaccine at the clinic (quality, expiry date…) Vaccine unavailable at the clinic Not good enough quality

Table 4.9: Primary reason cited by Lebanese respondents when asked why they did not go to a PHC, dispensary or MOSA/SDC clinic to vaccinate their child

70 “The PHCs have ‘fresh’ vaccines, due to high levels of turnover of vaccines and are also much cheaper than the private clinic. In contrast, the private clinic will take more time to examine the child and is generally cleaner.” Lebanese mother, Bekaa, June 2017 The time needed to reach the nearest PHC or dispensary varies across mohafazat. Only rarely, however, does it take longer than an hour to reach the nearest one. Respondents in Nabatieh reported needing the longest time to reach the nearest health centre, followed by the North. Most of respondents who did not know the time to reach the nearest health clinic were in Beirut at 25%, followed by Bekaa and Nabatieh at 23% and 22% respectively.

South North Mount Lebanon El Nabatieh Bekaa Beirut Baalbek-El Hermel Akkar

Under 30 min

87%

Baalbek-El Hermel 79%

Between 30 min – 1 h

9%

9%

Between 1-2 hours

2%

DK

1%

Akkar

12%

70%

El Nabatieh 46%

Mount Lebanon 72%

11%

6%

28%

2%

1%

3%

25%

23%

22%

Beirut

Bekaa

62%

North

South

79%

76%

11%

19%

13%

3%

1%

4%

13%

1%

7%

Table 4.10: Lebanese respondents’ time needed to reach the nearest health clinic by mohafaza Practice of antenatal care and child delivery Women in the Lebanese domain made extensive use of antenatal care (ANC). 94% of Lebanese mothers made use of antenatal care services during their last pregnancy. Of those, 90% of Lebanese mothers visited ANC four times or more during pregnancy.

71

1% 3% 6% 16% 74% Once

Twice

Three times

Four times

Over four times

Table 4.11: Lebanese mothers’ responses on frequency of ANC visits during their most recent completed pregnancy Which supplier of ANC they went to varies by mohafaza. 83% of Lebanese respondents in Bekaa, for example, used private clinics and hospitals for ANC, whereas just 24% of Lebanese respondents in Nabatieh did so. While 63% of Lebanese women accessed private hospitals for the ANC visits in the South, only 14 percent did so in Baalbek-Hermel.

South North Mount Lebanon

14%

13%

63% 6%

27% 12%

16%

Akkar

41%

52%

1%

20%

29%


23%

1%

63% 4%

42% 33%

29%

1% 12%

64%

Beirut Baalbek-El Hermel

26%

5%

El Nabatieh Bekaa

10%

5% 5%

37%

14%

49%

17%

MOSA clinic

16%

50% Public hospital

Private hospital

Private clinic

Table 4.12: By mohafaza: type of medical institution accessed by Lebanese female respondents with at least one child who visited antenatal care for the last child delivered For the 6% of Lebanese mothers who did not visit ANC during pregnancy, 34% replied that they did not visit an ANC because there were no complications with the pregnancy, 21% mentioned because it was not their first child and 19% in the Lebanese domain said that their financial status did not allow them to make use of ANC, highlighting vulnerability as a result of lack of financial means. “The doctor examines the women during pregnancy but does not necessarily offer advice. It is the same in dispensaries, there is no advice centre or person in charge there to help expecting mothers.” Lebanese mother, Bekaa, June 2017

72 Almost all women at 96% in the Lebanese domain delivered their child in a hospital. Just 2% did so in a private clinic and 1% at home. Almost half of Lebanese respondents say that they paid for the delivery themselves. The costs for a quarter of deliveries was covered by the Nation Social Security Fund. MOPH and the Army Fund paid for 19% of deliveries. Because respondents were able to name several options, payments for delivery might come from more than one source.

Cooperative of civil Servants

2%

National Social Security Fund

25%

Fund of the Internal Security Forces Fund of the army

2% 6% 13%

MOPH

14%

Private insurance

49%

Self

Table 4.13: Options cited by Lebanese respondents regarding who paid for the mother’s most recent delivery Attitude on exclusive breastfeeding The overwhelming majority of Lebanese respondents at 95% believe in exclusive breastfeeding. Of those, 95% state that exclusive breastfeeding provides good health for the child, around 30% state that they have seen good results from others and 18% state that it has been recommended to them by relatives. However, 9% of male and 15% of female respondents in the Lebanese domain also consider exclusive breastfeeding a good way to decrease family expenses. As shown in the graphic below, there is no significant gender difference between answers to this question.

73

3% Female

1% Male

15% 16% 18%

9% 14% 17%

29%

96%

25%

Immunity of the body It was recommended by a doctor or nurse I have seen good results from others

94% Breastfeeding is a good way to decrease family expenses It was recommended by family/relatives It provides good health

Table 4.14: Reasons cited by Lebanese respondents for believing in exclusive breastfeeding Another question about attitudes to breastfeeding asked until when respondents thought it was important to breastfeed. The majority of Lebanese respondents said that breastfeeding is important until the age of one year or two years. 44% of Lebanese respondents stated that breastfeeding until 24 months is important, while around a third stated until 12 months.

Female

2% 1% 1%

14%

3% 1% 1%

46%

Until 3 years Don't know Until 24 months Until 12 months Until 6 months

1% 1% Male

35%

15%

41% 38%

Until 3 months Until 1 month Never

Table 4.15: Lebanese respondents who state their attitudes towards the duration of breastfeeding If asked why mothers do not breastfeed or stop breastfeeding, with the option to provide multiple responses, 60% of respondents in the Lebanese domain reply that the mother does not have enough milk and 20% say that the baby is still hungry after breastfeeding and needs more food. The perception that the baby is still hungry might be related to inappropriate breastfeeding practices, such as scheduled breastfeeding for fixed amounts of time, which might be advised by relatives or medical

74 professionals. Moreover, mothers whose babies have been bottle-fed already will find it more difficult to initiate breastfeeding. “Along with breastfeeding I gave water with sugar and chamomile tea. And after 6 months, the baby will no longer be satisfied just with breastfeeding.” Lebanese mother, FGD in Akkar, May 2017 Close to a third of respondent’s state that ‘it is time to stop breastfeeding’. Almost a quarter of respondent’s state that the mother is sick and that this prevents her from breastfeeding, while 14% say that the mother has to work and that she therefore cannot breastfeed. A few percent mention reasons like maintaining the mother’s body and that medical staff advised against breastfeeding. Crucially, while it seems that initiation of breastfeeding is high, breastfeeding declines because of inadequate practice. To maintain her body

4% 3% 2% 3%

Don’t know Women don’t know how to breastfeed Doctor/health staff advised Mother has to work

14%

Mother is sick

23% 8% 11%

Baby is sick Baby cries at night

20% 60% 31%

Baby is hungry, needs more food Not enough milk It’s time to stop breastfeeding

Table 4.16: Reasons cited by Lebanese for why mothers do not breastfeed or stop breastfeeding

4.3.3. Syrians registered with UNHCR domain Knowledge on vaccination under 1 year of age In the registered Syrian domain, 55% of respondents know that at least six vaccination sessions are needed before the first birthday for the child to have received all recommended vaccines. While 17% answer that they do not know the required number of vaccination sessions, 27% underestimate the number.

75

4% 9% 14% 17% 23% 32% 3

4

5

DK

6

Above 6

Table 4.17: Results of Syrian caretakers registered with UNHCR being asked how many vaccination sessions children of the age of one year need to have completed “When the baby is born in the hospital in Syria, they give him the first vaccine. I was not there with my wife so I do not know what vaccines the child received.” Syrian father, FGD in Mount Lebanon, May 2017 When asked where they usually go to receive vaccinations for their children, an overwhelming majority of respondents in the registered Syrian domain replied that they go to PHCs or dispensaries. This finding is validated by FGDs, in which Syrians state making mostly use of health centres affiliated with NGOs. In distant second place for vaccination service provider come MOSA. The difference between female and male respondents is not significant.

1% Female

Male

1% 1% 1%

DK

9%

Not applicable

10%

3% 5% 2% 1% 1% 8%

Health care worker visits the house

75%

Mobile clinics Private clinic MOSA clinic

80%


Table 4.18: Results by gender of Syrian respondents registered with UNHCR asked where they usually go to receive a vaccination for their child The primary reason for not going to a PHC or dispensary for vaccination given by registered Syrians is that a vaccinator is not available at the PHC and that they cannot afford vaccinations at the PHC. Critically, the issue does not seem to be that there are vaccine stock-outs, as this is very rare for routine immunization, but rather that no vaccinator is always available. Another reason is that respondents in the registered Syrian domain find the quality of PHCs not good enough. Lack or the cost of transportation are other reasons, as is unfriendly staff at the PHCs.

76 “When we go to the UN to renew our registration card, they give our children vaccinations and we do not pay anything.” Syrian mother, FGD in Baalbek-Hermel, June 2017

Lack of knowledge about available health centres/ UNRWA clinic Family member or friend advised against it Unfriendly staff/environment

4% 7% 12% 12% 11%

No transportation Too expensive to get to clinic Vaccinator not available at clinic

20% 20%

Do not have enough money to vaccinate

7%

Vaccination too expensive

4%

Do not trust vaccine at the clinic (quality, expiry date…) Vaccine unavailable at the clinic

9%

19%

Not good enough quality

Table 4.19: Primary reason cited by Syrian respondents registered with UNHCR when asked why they did not go to a PHC, dispensary or MOSA/SDC clinic for vaccination The response that the lack of transportation is a reason for not visiting the PHC for vaccination is surprising as answers to the question about the time needed to reach the nearest PHC reveal that registered Syrians rarely need more than an hour to get to the nearest PHC. Indeed, depending on mohafaza, 73-86% respond that they need under 30 minutes to reach the nearest PHC.

South North Mount Lebanon El Nabatieh Bekaa Beirut Baalbek-El Hermel Akkar

Under 30 min

77%

Baalbek-El Hermel 76%

Between 30 min – 1h

23%

21%

23%

12%

3%

3%

3%

Akkar

Beirut

Bekaa

El Nabatieh

73%

85%

86%

Mount Lebanon 86%

12%

11%

Between 1-2 hours DK

2%

North

South

78%

77%

21%

20% 2%

2%

1%

77 Table 4.20: Time needed by Syrians registered with UNHCR to reach the nearest health clinic by mohafaza

Practice of antenatal care and child delivery 87% of Syrian mothers registered with UNHCR visited antenatal care for their last child. Of those, 64% answered that they visited ANC four times or more for the last child they delivered. Over one third report that they made use of ANC three times or less.

4% 10% 21% 26% 38% Once

Twice

Three times

Four times

Over four times

Table 4.21: Responses of Syrian mothers registered with UNHCR on frequency of ANC visits during their most recent completed pregnancy What type of medical facility mothers-to-be went to for ANC varied across mohafazat, as can be seen in the table below. In the North, Akkar and Beirut, Syrian mothers registered with UNHCR mostly visited PHCs and dispensaries. South and Baalbek-Hermel show the highest rates of visits to public hospitals.

48%

South

36%

56%


26%

7%

8%

17%

29%

4% 10%

35%

75%

Beirut

44%

Akkar PHC or dispensary supported by UN/NGOs

25% 24%

75% MOSA clinic

18%

8% 11%

38%

51%

Bekaa

Baalbek-El Hermel

3%

79%

North

15%

3%

29% 7%

Public hospital

18%

Private hospital

Private clinic

Table 4.22: By mohafaza: type of medical institution accessed by Syrian female respondents registered with UNHCR with at least one child who visited antenatal care for the last child delivered

78 Close to a third of respondents in the registered Syrian domain stated that the mother did not make use of ANC because there were no complications in the pregnancy. As many as 18% replied that they were not aware of the possibility to use ANC and just as many replied that their financial status did not permit them to visit a medical facility that provides ANC. When asked about the delivery of the last child, most Syrian respondents registered with UNHCR at 88% reported that mothers went to a hospital. Just 5% stated that women delivered a child at home or in a tent, 4% delivered in a private clinic, 2% in a PHC. Of those respondents who delivered in a hospital, private clinic or PHC, 62% replied that they covered the costs of delivery themselves, while 52% in the domain of Syrians registered with UNHCR said that UNHCR, some other UN organization or MOPH had paid for the delivery. This data also points towards cost-sharing of deliveries, meaning that there is more than one source to cover the financial cost of the delivery. Because respondents were able to name several options, payments for delivery might come from more than one source.

7% 1% 5% 18% 62% 29% Donations from friends or relatives MOPH Self

DK NGO/UN (including UNRWA) UNHCR

Table 4.23: Options cited by Syrian respondents registered with UNHCR on who paid for the mother’s most recent delivery

Attitudes on exclusive breastfeeding Around 95% of Syrians registered with UNHCR stated that they believe in exclusive breastfeeding. The most common reason, given by 91% of respondents in the registered Syrian domain, for why they believe in exclusive breastfeeding is that it provides good health. Learning from the experience of other women is another often mentioned reason (33%) for believing in exclusive breastfeeding. There is no significant difference between answers provided by female and male respondents.

79

2% Female

1% Male

22% 19% 25%

15% 16% 20%

35%

92%

31%

91%

Immunity of the body

Breastfeeding is a good way to decrease family expenses

It was recommended by a doctor or nurse

It was recommended by family/relatives

I have seen good results from others

It provides good health

Table 4.24: Reasons cited by Syrian respondents registered with UNHCR for believing in exclusive breastfeeding When asked until when respondents thought it important to breastfeed, a majority of registered Syrian respondents at 64% think that breastfeeding was important to the age of 24 months and another 30% maintain that it is important until the age of 12 months. “In the hospital, they did not train us on how to breastfeed but prescribed us formula milk. They used to distribute formula in the hospital and my husband bought it for LL 20,000.” Syrian mother, FGD in Baalbek-Hermel, June 2017

Female

65%

29%

2% 1% 1% 1% 1%

Male

3% 1% Until 3 years Until 6 months

63%

31%

Don't know Until 3 months

Until 24 months

Until 12 months

Until 1 month

Never

Table 4.25: Syrian respondents registered with UNHCR who state their attitudes towards the duration of breastfeeding “The doctor advised me to breastfeed because it gives child immunity, better health and increases the bond between mother and child.” Syrian mother, FGD in Beirut, May 2017

80 The most common answer at 63% among respondents in the registered Syrian domain to the question why mothers do not breastfeed or stop breastfeeding, which was asked as a question with multiple possible answers, was that the mother does not have enough milk. A common related answer is that the baby is still hungry after breastfeeding and needs more food at 29%. Another, at 37% even more common, answer is that it is time to stop breastfeeding. Fewer registered Syrian than Lebanese respondents stated that breastfeeding is impossible because the mother is sick or has to work. Second pregnancy

2% 1% 2% 2% 2% 3% 4% 6%

Neglect To maintain her body Don’t know Women don’t know how to breastfeed Someone else advised Doctor/health staff advised Mother has to work

16% 11% 15%

Mother is sick Baby is sick Baby cries at night

29% 63% 37%


Table 4.26: Reasons cited by Syrian respondents registered with UNHCR for why mothers do not breastfeed or stop breastfeeding

4.3.4. Syrians in ISs domain Knowledge on vaccination under 1 year of age All respondents in the Syrian in ISs domain know that children of the age 12 months and under need to complete the recommended vaccinations. When asked how many vaccination sessions a child of one year needs to have completed to have received all recommended vaccines, 55% know that the answer is at least six. In contrast, 28% underestimate the number of sessions needed and 19% do not know.

81

4% 4% 6% 14% 19% 27% 28% 3

2

4

5

DK

6

Above 6

Table 4.27: Results of Syrian caretakers in ISs being asked how many vaccination sessions children of the age of one year need to have completed

Upon the question where they usually go to receive vaccinations for the children, most respondents answer PHC, dispensary, MOSA or public hospital. Very few, less than 5%, say that they visit a private clinic for vaccination. In the Syrian in ISs domain, there are differences in how women and men answer this question. Noticeably, male respondents seem unaware of MOSA as outlets for immunization and might confuse them with PHCs, which would explain why more men than women mention PHCs as suppliers of vaccination.

1%

19%

1% Female

12%

3% 3%

19%

5%

14%

2% Male

42%

16%

5% 5%

55% % DK Public hospital

10%

20%

30%

40% Not applicable

50%

60%

Health care worker visits the house

Mobile clinics

Private clinic

MOSA clinic


Table 4.28: Results by gender of Syrian respondents in ISs when asked where they usually go to receive a vaccination for their child When asked about the primary reason for not going to PHCs or dispensaries for vaccination, the most common response at 20% in the Syrian in ISs domain is a lack of knowledge about available PHCs. The cost for transportation to, and vaccination at, PHCs and dispensaries is the second most common

82 answer at 17% respectively. At 14%, family members and friends advising against vaccination at PHCs and dispensaries is another reason for not accessing them for vaccination. Lack of knowledge about available health centres/ UNRWA clinic Family member or friend advised against it Unfriendly staff/environment

20%

14% 2%

No transportation

8%

Too expensive to get to clinic

17% 17%

Vaccinator not available at clinic Do not have enough money to vaccinate Vaccination too expensive

14% 8% 2% 2%

Do not trust vaccine at the clinic (quality, expiry date…) Vaccine unavailable at the clinic

3%

Not good enough quality

Table 4.29: Primary reason cited by Syrian respondents in ISs when asked why they did not go to a PHC, dispensary or MOSA/SDC clinic

Practice of antenatal care and child delivery 91% of Syrian mothers in ISs sought antenatal care for the last child delivered. For the delivery of their last child, 63% of the female Syrian respondents in the ISs domain stated that they visited a provider of ANC four times or more during pregnancy; 20% went just once or twice. Reasons for not making use of ANC include that it was not the respondents’ first child, that there were no complications and that it was a financial issue.

8% 12% 15% 17% 48% Once

Twice

Four times

Three times

Over four times

Table 4.30: Syrian mothers in ISs’ responses on frequency of ANC visits during their most recent completed pregnancy For the last child that was delivered, almost 80% of respondents in the Syrian in ISs domain stated that the mother delivered in the hospital. As many as 10% reported that deliveries have occurred in tents, but almost as many have given birth in a private clinic. While 79% of Syrians in ISs bore the costs

83 for the delivery themselves, 43% of deliveries were paid for by UNHCR and other UN-sponsored organizations. Because respondents were able to name several options, payments for delivery might come from more than one source.

3% 1% 1% 4% 1%

Donations from friends or relatives DK National Social Security Fund MOPH Private insurance

15%

NGO/UN

79% 28%

Self UNHCR

Table 4.31: Options cited by Syrian respondents in ISs on who paid for the mother’s most recent delivery

Attitudes on exclusive breastfeeding Syrian respondents in ISs believed to 99% that exclusive breastfeeding was beneficial. By far the most common answer to the question why Syrians in ISs believe in exclusive breastfeeding is that it provides good health, which was validated by FGDs and KIIs. To have seen good results from others and that it was recommended by doctors, nurses or relatives are other responses. Only 7-11% answered that it reduces family expenses.

4% Female

Male

11% 6% 7% 12%

7% 5% 7%

97%

12%

100%







Table 4.32: Reasons cited by Syrian respondents in ISs for believing in exclusive breastfeeding There appears to be some agreement in the Syrian in ISs domain on how long a mother should breastfeed. 85% think that breastfeeding is important until the child is 24 months old; 11% believe that breastfeeding is important until 12 months.

84

1% 1% 86%

Female

10% 1%

80%

Male

20% Until 18 months

Until 3 years

Until 24 months

Until 12 months

Until 6 months

Table 4.33: Syrian respondents in ISs stating their attitude towards the duration of breastfeeding When asked why mothers do not breastfeed or stop breastfeeding, which was asked as a question with multiple possible responses, 68% of the respondents in the Syrian in ISs domain answer that it is because the mother does not have enough milk and 30% say that it is because the baby is still hungry after breastfeeding; 13% mention that the mother is sick and therefore is unable to breastfeed. Second pregnancy To maintain her body

4% 5% 4% 1% 1% 1% 4%

Don’t know Women don’t know how to breastfeed Someone else advised Doctor/health staff advised Mother has to work Mother is sick

13% 6% 8%

Baby is sick Baby cries at night

30%

68% 20%


Table 4.34: Reasons cited by Syrian respondents in ISs for why mothers do not breastfeed or stop breastfeeding

4.3.5. Palestine refugees domain Knowledge on vaccination under 1 year of age As good as all respondents in the Palestine refugee domain know that children until their first birthday need to take vaccines. Of all Palestine refugee respondents, 53% know that a child needs at least six vaccination sessions to receive all of the recommended vaccines.

85

8% 11% 13% 15% 23% 30% 3

4

6

5

DK

Above 6

Table 4.35: Results of Palestine refugee caretakers being asked how many vaccination sessions children of the age of one year need to have completed “I have not vaccinated my child or taken him to the health centre. I think that assistance to Palestinians is restricted to those residents within the UNWRA camps. I am not sure if Syrian Palestinians like me can qualify for aid.” Palestine refugee father, FGD in South, June 2017 When asked where they usually go to have their children vaccinated, Palestine refugees almost unanimously respond that they take their children to the UNRWA health centre. As a matter of fact, UNRWA healthcare staff are efficient in reminding new mothers when to come back for the child’s next vaccine session. As UNRWA is working on putting in place an e-health system, to keep a paperless record of all patients, and vaccination sessions, reminders will soon become more automated and easier to conduct.

95%

Female

3%

1% 96%

Male

3% Not applicable

UNRWA clinic


Table 4.36: Results by gender of Palestine refugee respondents asked where they usually go to receive a vaccination for their child “UNRWA reminds us about our children’s vaccinations, they call us to make appointments and gives us instructions and leaflets to read about the importance of vaccination. We trust UNRWA’s health centres, we know that there are regular

86 quality checks and the staff are from our own community.” Palestine refugee mother, FGD in the North, May 2017 Practice of antenatal care 87% of female Palestine refugee respondents with at least one child visited antenatal care for the last child. Of those mothers, 75% visited ANC at least four times. A higher rate of ANC visits among Palestine refugees compared to Syrians could be explained by the effective follow-up by UNRWA on antenatal care.

7% 8% 12% 13% 62% Three times

Twice

Once

Four times

Over four times

Table 4.37: Palestine refugee mothers’ responses on frequency of ANC visits during their most recent completed pregnancy

Attitudes on exclusive breastfeeding A total of 97% of Palestine refugee respondents believe in exclusive breastfeeding. Out of those, 99% believe that breastfeeding provides good health. More than in any of the other domains, respondents also mentioned that breastfeeding was a good way to decrease family expenses and for mother-child bonding.

1% 3% Female

21% 10% 14% 18%

2% 1% Male

17% 21% 25%

98%

33%

100%

Breastfeeding brings the baby closer to the mother







Table 4.38: Reasons cited by Palestine refugee respondents for believing in exclusive breastfeeding

87 53% of Palestine refugee respondents think that it is important to breastfeed children until 24 months, while 44% believe it is important to do so until 12 months. In an FGD with Palestine refugee mothers in the North of Lebanon, many reasons were cited for the importance of breastfeeding, including to strengthen the child’s immunity, providing the child with the right nutrition and to protect the mother from breast cancer. Breastfeeding as a way to decrease family expenses was also mentioned along with it being more practical than bottled milk feeding, since there was no need to sterilize bottles. This argument also mentioned by Syrian mothers in the registered domain. “Breastfeeding for two years is an advice passed on from the older generation and it is even written in the Quran.” Palestine refugee mother, FGD in the North, May 2017

Female

48% 48%

3% 1%

1% Male

39%

1%

59%

1% Until 3 years Until 3 months

Until 24 months Until 1 month

Until 12 months Never

Until 6 months

Table 4.39: Lebanese respondents who state their attitude towards the duration of breastfeeding When asked about why mothers stop breastfeeding or do not breastfeed in the first place, a question which allowed multiple responses, almost 60% of Palestine refugee respondents believe that mothers do not breastfeed or stop breastfeeding because they do not have enough milk. An additional 46% mention as a cause that the baby is still hungry after breastfeeding. Almost a third of the respondents in the Palestine refugees domain point to the mother being sick as the reason for not breastfeeding.

88 Second pregnancy

1% 3% 4% 3% 4%

Neglect To maintain her body Women don’t know how to breastfeed Someone else advised Doctor/health staff advised

10% 15%

Mother has to work

29%

Mother is sick

18%

Baby is sick

24%

Baby cries at night

46% 58% 49%


Table 4.40: Reasons cited by Palestine refugee for why mothers do not breastfeed or stop breastfeeding

Bibliography Brinkmann, Suzanne. 2016. Breastfeeding in emergency response settings: Barrier analysis with Syrian refugees. Washington, D.C.: International Medical Corps. Government of Lebanon, and United Nations. 2017. Lebanon Crisis Response Plan 20172020. Beirut: Government of Lebanon and United Nations. Lyles, Emily, and Shannon Doocy. 2015. Syrian refugee and affected host population health access survey in Lebanon. Baltimore, Maryland: Bloomberg School of Public Health, Johns Hopkins University, and Médecins du Monde. Nabulsi, Mona. 2011. ‘Why are breastfeeding rates low in Lebanon? A qualitative study’. BMC Pediatrics 11: 75. Osman, Hibah, Lama El Zein, and Livia Wick. 2009. ‘Cultural beliefs that may discourage breastfeeding among Lebanese women: A qualitative analysis’. International Breastfeeding Journal 4: 12. Perera, Shiromi, and Amelia Reese Masterson. 2016. Barrier analysis of exclusive breastfeeding, minimum dietary diversity and early antenatal care seeking behaviors of Syrian refugees in Lebanon. Washington, D.C.: International Medical Corps. UNHCR. 2016. At a glance: Health access and utilization survey among Syrian refugees in Lebanon. Beirut: UNHCR. UNHCR, UNICEF, and WFP. 2016. Vulnerability assessment of Syrian refugees in Lebanon 2016. Beirut: UNHCR, UNICEF and WFP. UNICEF. 2016. Lebanon baseline survey 2016. Beirut: UNICEF.

89 UNICEFa. 2017. Breastfeeding. Accessed 26 September 2017. www.unicef.org/nutrition/index_24824.html. UNICEFb. 2017. Health. Accessed 26 September 2017. www.unicef.org/health/index_4020.html. UNICEFc. 2017. Immunization. Accessed 26 September 2017. www.unicef.org/immunization/. UNICEFd. 2017. ‘UNICEF in Lebanon and immunization campaigns’. Human and Health 38: 12–15. UNICEF, OCHA, and REACH. 2015. Defining community vulnerabilities in Lebanon. Assessment report September 2014 – February 2015. Beirut: UNICEF, OCHA, and REACH. WHOa. 2017. ‘Exclusive breastfeeding’. Accessed 26 September 2017. www.who.int/nutrition/topics/exclusive_breastfeeding/en/. WHOb. 2017. ‘Immunization’. Accessed 26 September 2017. www.who.int/topics/immunization/en/. WHO and UNICEF. 2016. Lebanon: WHO and UNICEF estimates of immunization coverage: 2016 revision. WHO and UNICEF. www.who.int/immunization/monitoring_surveillance/data/lbn.pdf?ua=1.

90

5. WATER, SANITATION AND HYGIENCE (WASH) This chapter provides a baseline for the programmatic area of water, sanitation and hygiene or WASH. UNICEF works worldwide to secure children’s access to safe water and basic sanitation, and to nurture appropriate hygiene practices. Interconnected interventions in the fields of water, sanitation and hygiene, WASH, are essential for the survival and development of children.29

5.1. Situation analysis 5.1.1. WASH sector response The overall WASH response in Lebanon is geared towards increasing the percentage of -

Households with access to safe and sustainable drinking water Girls, boys, women and men with appropriate hygiene knowledge and practices Households with safely managed waste and wastewater.

More than 3.7 million persons are in need of WASH support, of whom nearly 2 million are targeted. 30 Lebanon’s ‘alarming water and sanitation situation’31 is especially hazardous when compounded by poor hygiene practices. Vulnerable population groups are particularly at risk.32 Children have already been affected by outbreaks of dysentery, Hepatitis A and typhoid.33 16% of Syrian refugees reported a lack of access to showering or washing facilities.34 Due to a lack of access to safe sanitation and means for personal hygiene, women and adolescent girls face risks to health, protection and dignity, especially when living in informal settlements or substandard shelters.35

5.1.2. Baseline indicators Knowledge on appropriate hygiene practices “Something as simple as handwashing can save lives”36 Washing hands with soap at critical times, like after going to the toilet or before eating, can have a significant impact on children’s health. Good hygiene practices reduce the incidence of diseases such as pneumonia, trachoma, scabies, skin and eye infections and diarrhoea-related diseases like cholera 29

UNICEF 2017b.

30

Government of Lebanon and United Nations 2017: 157.

31

Ibid: 14; for more details, see ibid: 157-170.

32

See, e.g., Noone 2016 and World Vision International 2014.

33


34

Ibid: 160.

35

Ibid.

36

UNICEF 2017a.

91 and dysentery. Research shows that regular handwashing with soap can reduce the number of incidents of diarrhoea, a disease which can be deadly for children, by around 50 percent.37 Education and communication are important components of promoting hygiene, however education alone does not necessarily result in improved practices. Promoting behaviour change is a gradual process that involves working closely with communities, studying existing beliefs, defining motivation strategies, designing appropriate communication tools and finally, encouraging practical steps towards positive practices. Communities should be fully engaged in the process at all stages using participatory processes, and special attention should be given to building on local knowledge and promoting existing positive traditional practices.38 The 2016 vulnerability assessment among Syrian refugee households revealed that a large majority, 90%, has access to cleaning items. 87% of refugees have access to personal hygiene items, 86% to female hygiene items, and 78% to baby care items. A mere 2% of households had received hygiene kits during the three months preceding the survey, while 1.5% had received hygiene training within the previous six months. Geographically, least access to hygiene items was observed in Beirut and Baabda (see table 5.1).39

37

Ibid.

38

Ibid.

39

UNHCR, UNICEF, and WFP 2016: 25.

92

Table 5.1: Access to hygiene items in selected districts in Lebanon40 As for the Palestine refugees’ domain, most PRS families reported sufficient access to soap and other hygiene items. The only exception is North, where 50.7% of families residing inside camps and 46% of those residing outside camps reported having no access to soap and other hygiene items.41 Little has been written about hygiene knowledge and practices within the Lebanese domain. A study on intimate hygiene among Lebanese women, however, considers ‘education about adequate feminine hygiene practices […] crucial to improve Lebanese women’s reproductive health’.42 The same study calls for a ‘cross-sectional study on a sample of women […] all over Lebanon’, comparing ‘results obtained before and after educational campaigns, personal hygiene classes or other informative interventions’.43 In order to monitor the increase in hygiene practices over time, this KAP Study sets a baseline for the following indicator: % increase of boys, girls, women and men with appropriate hygiene knowledge and practices. According to LCRP 2017-2020, progress will be measured every two years (see figure 7.2.).

40

Ibid.

41

Abdulrahim and Harb 2015: 27.

42

Attieh et al 2016.

43

Ibid.

93

Table 5.2: Indicator targets as per LCRP 2017-202044

5.2. Qualitative findings summary 5.2.1. Supply and demand of services Issues of WASH highlight the challenges of moving from an emergency response towards a more development-oriented response. The latter would involve tackling issues in a more medium-term way, ensuring sustainability to services and programmes. In the case of WASH, however, the emergency response is a persisting solution to the supply of basic services. Water In Lebanon, there are five main supply sources of water: Public Private - The sources and grids of regional water - Private wells establishments - Water delivered by truck - Municipal wells - Bottled water Table 5.3: Water supply sources in Lebanon These sources of water are of varying quality and supply different levels of quantity. Water sources like wells, rivers and dams generally suffer from bacteriological and chemical contamination. Coastal wells, in addition, are exposed to sea water intrusion. The ground water is polluted from industrial effluents, fertilizers, pesticides, disposal of untreated sewage into the environment etc. The water that reaches the household is therefore mostly of poor quality. Respondents in the FGDs say that they prefer bottled water as their primary source of drinking water. FGD data also indicate that rumours about the quality of bottled water flourish, with respondents sharing what they have heard to be true about the quality of the different brands of bottled water. Delivering water by truck is common even in urban areas like Beirut. The truck delivers water that is pumped into cisterns. Customers have concerns that cisterns are not filled completely by the delivery service and that the water tastes and smells bad. Distributing water by truck is associated with emergencies, but in Lebanon it has become a routine method of water supply. 44


94

A systemic issue is the dependency of water establishments and private wells on electric pumps. Approximately 85% of the water that is distributed by water establishments is being pumped out of the ground. That makes the distribution of water depend on the supply of electricity and thus vulnerable to power cuts. A solution envisioned by central and regional water authorities is the construction of dams on higher altitudes, so that pipe pressure is achieved through gravity. In the meantime, demand for water is increasing as Lebanon’s population and built environment grows. More and more wells are being dug at ever greater depth. The tipping point at which the consumption of water from Lebanese sources exceeds the natural capacity for the replenishment of same sources may already have passed, according to a KII with a general director of one of Lebanon’s four water establishments. Hygiene The main challenge to appropriate hygiene practices are of practical and financial nature. Lack of available or clean water, limited financial means to procure water or soap and other cleaning material, such as shampoo, washing liquid or detergent, present challenges especially for Syrian refugees. While most respondents in FGDs and in the survey had positive attitudes towards handwashing, anecdotal evidence from KIIs with individuals working closely with ISs in Akkar point towards some lack of knowledge and practice in using soap in handwashing. In refugee settlements and camps, as well as in public spaces like schools, the use of latrines can present major challenges. In Syrian refugee camps, latrines are usually not divided according to gender with latrines for women and latrines for men. Instead, they tend to be allotted to one or more households. Ideally, one household has one toilet to itself. A particularly sensitive issue is menstruation. For women, and even more for girls, to share a latrine during menstruation can be challenging. Some girls do not attend school during their period because clean and properly functioning toilets are not available in their schools. Solid waste Solid waste is another critical issue in Lebanon. Landfills are used beyond their capacity and illegal waste dumps of various age and size can be found across Lebanon. At the household level, collection of solid waste is not organized in a nationally standardized fashion. UNICEF and other UN organizations, as well as different NGOs, provide waste bins in many parts of the country. Sanitation Lebanon’s systems for collecting and treating domestic, industrial and other types of wastewater are insufficient. Most of the country is not covered by collection systems. Instead, wastewater is released into above-ground open holding pits, soak pits, septic tanks and directly into the environment. Even wastewater transported through collection systems will, by and large, remain untreated before it is released into the sea. There are approximately 53 wastewater outfalls into the Mediterranean Sea along Lebanon’s coastline.45 A particularly sensitive case is that of Syrian refugee settlements. National policies prevent the construction of more permanent or at least more sustainable structures for water supply and sanitation treatment. NGOs nevertheless attempt to find better solutions than releasing unfiltered, untreated wastewater directly into the environment. At the moment, the most common method of collecting domestic wastewater in tented settlements is in open concrete holding structures and to a much lesser extent in soak pits. A problem with underground pits is that they need frequent

45

Ministry of Environment Lebanon 2001: 234.

95 desludging. Pilot projects with septic tanks for black water and filters for grey water in tented settlements have begun by an NGO in the North mohafaza.


Mount Lebanon

Akkar

North

Bekaa

BaalbekHermel

South

Nabatieh

Syrian fathers

Syrian mothers

Lebanese girls


Syrian girls (IS)

Lebanese boys

Lebanese fathers

Syrian mothers

Table 5.4: WASH FGDs matrix An analysis of the qualitative data on the issue of WASH points towards a strict gender division in households across all domains. While men are responsible for ensuring the household has access to water for drinking and general usage, women are responsible for everything else having to do with the hygiene and cleanliness of children and the household as a whole. Caretaking responsibilities in this regard seem to be clearly divided with children’s wellbeing placed under the mother’s care, which is confirmed by the fact that female respondents supply a wealth of data on hygiene, whereas male respondents have much less to say about the matter. “My wife is the main person in charge of cleanliness of the home and the hygiene of the children.” Syrian father, FGD in Beirut, May 2017 A strong barrier to appropriate hygiene practices is of a financial nature. Menstruation, for example, adds a financial burden. Syrian and Palestine refugee women and girls are often forced to use sanitary items sparsely. The supply of water is another challenge. Most often, drinking water is purchased while water for general use such as showering and cleaning is provided by an aid agency to Syrian and Palestine refugees (unless it also has to be bought). Syrian respondents in ISs are supplied with necessary water for drinking and general use by UNICEF. Palestine refugees and Lebanese respondents living in the South are supplied with water for general use by UNRWA, UNIFIL or are part of the national water network. The need to buy water places a financial burden especially on Syrian refugees who live in collective shelters and rented apartments. Procuring hygiene and cleaning products are also an issue. All Syrian respondents spoken to stated that dishwashing liquid, laundry detergent, shampoo and other cleaning products are very expensive, causing them to choose cheaper and less effective products or substitute products. Syrians also mention borrowing from their nearest shops to be able to get hold of hygiene and cleaning products. Few of the Syrian respondents have heard of fellow Syrians who informally sell products they do not need. “We often have to by from shops on credit and pay back our debt whenever we have any money. It happens that I do not have a product, so I substitute another for it, for example I use shampoo to clean the floor or for washing dishes.” Syrian mother, FGD in Nabatieh, June 2017 Qualitative data of the KAP Study show that many women and girls are convinced that showering and bathing during menstruation is unhealthy, even dangerous. Reasons given is that the poor quality of the water can bring about bacterial infections, that showering can cause fibrosis, that one can get “a sack of water in the uterus”, and so on. Consequently, many girls do not shower in the first days of the

96 period and some refrain from cleaning their body for the entire period. Girls are discouraged from showering during menstruation by relatives and one girl reports that her doctor told her not to shower during her period. There seems thus to be a lack of knowledge among female respondents on appropriate hygiene practices during menstruation. “I was told that if I shower on the first day [of menstruation] it will cause a problem. I am unsure what will happen, maybe I would get sick.” Lebanese girl, FGD in Akkar, May 2017

5.3. Baseline indicators: WASH 5.3.1. All domains Water Overall, 52% of total respondents state that the members of their household use bottled water as the primary source of drinking water. 28% cite piped water as primary source and 12% name either protected or unprotected wells or springs as their primary source of drinking water.

52%

Bottled water/ fountain gallon water

17%

Piped water supply (WE network)

11%

Piped water supply (Local well managed by WE)

8%

Protected well/spring Tanker-Trucking

4%

Unprotected well/spring

4% 3%

Piped water supply (local well managed by municipality) Rain water (underground reservoir)

1%

Surface water (river, stream, dam, lake, pond, canal, irrigation channel)

1% 0%

10%

20%

30%

40%

50%

60%

Table 5.5: Main source of drinking water as cited by total domains Hygiene The vast majority of respondents at 99% use soap when handwashing. The three most-mentioned important times to wash hands are before eating cited by 73% of all respondents, after returning home from outside cited by 67% and before preparing food cited by 66%.

97

73%

Before eating When returning to house from work/ from outside

67% 66%

Before preparing food

48%

After going to the bathroom

44%

Before feeding the baby/child After changing baby/child diapers

34%

After eating

1%

When necessary

1%

Table 5.6: Most important times to wash hands during the day as cited by total domains When asked about the most important ways to prevent disease transmissions, with the choice of multiple responses, respondents had a mixed level of knowledge. The most stated response was handwashing before eating, at 69%, the second-most handwashing after using the bathroom at 62% and proper cooking and cleaning practices at almost 50%. 69%

hand-washing before eating hand-washing after using the bathroom proper/ cleaning/washing vegetables before cooking/eating

49%

Drinking treated water

48%

62%

Use of treated/ properly stored water for cooking hand-washing after cleaning children/ disposal of diapers

43% 42% 36%

proper cooking of food hygienic bathrooms

31%

Table 5.7: Most important ways to prevent disease transmission as cited by total domains Solid waste The most common type of solid waste for total respondents is food scraps at 74%. The second most common type of solid waste is plastic at 59%.

98 Food scraps

74%

Plastic

59%

Papers

44%

Cans

11%

Glass Cloth

10% 1%

Table 5.8: The two most common types of households’ solid wastes for total domains 63% of total households dispose of waste in municipal containers, while 21% dispose of them through a collector. Critically, 13% of households dump their waste randomly although in closed bags. Of the 5% of households who sort their waste at source, almost 70% sort their organic waste, 55% sort recyclable materials and 30% sort non-recyclable materials. 63%

Waste is disposed in municipal containers

21%

Collector (company, natour, municipality) Waste is dumped randomly in closed bags (spread between tents/houses) –

13%

Waste is sorted at source (i.e. inside the home) Waste is dumped randomly (spread between tents/houses) Waste is burned

5% 3% 1%

Table 5.9: Ways in which households usually dispose of solid waste for total domains Sanitation Overall, 62% of total households do not share their toilet or latrine with individuals who are not from their household. Of those respondents who report that their household shares the toilet or latrine with others, 61% would qualify it as clean, 27% as somewhat clean and 12% as not clean.

No

62%

Yes No toilets / latrines

37% 1%

Table 5.10: Total households who share their toilet or latrine with other households or individuals

99

5.3.2. Lebanese domain Water More than half of the respondents in the Lebanese domain say that the members of their household use bottled water as the primary source of drinking water. 33% cite piped water as primary source and 12% name either protected or unprotected wells or springs as their primary source of drinking water. “We buy gallons of drinking water. We must buy drinking water to meet our needs.” Lebanese father, FGD in South, June 2017


1%

Tanker-Trucking

1%

Piped water supply (local well managed by municipality)

3%


4% 8%

Protected well/spring

12%


18%


54% Bottled water/ fountain gallon water

Table 5.11: Main source of drinking water for households of Lebanese residents Hygiene 51% of Lebanese respondents state using bar soap in handwashing, while 49% use liquid soap. When asked about the most important times to wash hands, with multiple responses possible, female respondents provide more varied responses than male respondents. While the most stated responses for Lebanese female respondents are after changing the baby’s diapers at 69%, before feeding the baby and before preparing food at 67% respectively, the most stated responses for men are after eating at 46%, when necessary at 44% and after returning home from outside at 40%. Gender differences become especially visible in relation to hygiene practices that are part of caring for babies and children. While almost three quarters of female respondents state that it is important to wash hands after changing the baby’s diapers, only 31% of male respondents mention this occasion. Similarly, 67% of female respondents state the importance of washing hands before feeding the child or baby, compared to 33% of male respondents. “My mother and older sister taught me about how to wash myself properly. I shower and change my clothes.” Lebanese girl, FGD in Akkar, May 2017

100

56% 54% Female

63% 61% 60%

31%

Male

33% 33% When necessary After going to the bathroom Before eating Before preparing food

37%

69% 67% 67%

44% 46%

39% 40% After eating After changing baby/child diapers Before feeding the baby/child When returning to house from work/ from outside

Table 5.12: Lebanese respondents citing the most important times to wash hands during the day Qualitative data from FGDs highlight the gender division with respect to taking care of household members. It is women, not men, who generally care for babies’ and children’s hygiene and who see to it that household members follow appropriate hygiene practices, which might explain the lower response rates among male respondents.

62% 65% 65% 61% 59% 62% 60% 61%

Female

Male

38% 35% 35% 39% 41% 38% 40% 39%

hygienic bathrooms proper/ cleaning/washing vegetables before cooking/eating proper cooking of food Use of treated/ properly stored water for cooking Drinking treated water hand-washing after cleaning children/ disposal of diapers hand-washing after using the bathroom hand-washing before eating

Table 5.13: Lebanese respondents citing the most important ways to prevent disease transmission amongst people “The mother is responsible for the cleanliness and hygiene of children and family.” Lebanese father, FGD in the South, June 2017

101 Solid waste Food scraps are the most common type of solid waste in Lebanese households at 74%. In second place comes plastic at 59% and in third place paper at 44%. Glass and cans are other, less common types of solid waste. Cloth was also mentioned as a common type of solid waste. Data from the FGDs indicates that Lebanese and Palestine refugees would be interested in sorting their waste. What stops them from doing so is a lack of trust in the waste management system, arguing that waste that is sorted at home will still be disposed of together in the same containers. Syrian respondents in FGDs stated facing increased stress because of their vulnerability levels, and while most had positive attitudes towards sorting waste, practical reasons seem to be the barrier, such as not having access to municipal containers.

2% 10% 11% 44% 74% 59% Cloth

Cans

Glass

Papers

Food scraps

Plastic

Table 5.14: The two most common types of solid wastes in Lebanese households A majority of Lebanese respondents, 62%, reply that they use municipal containers to dispose of their household’s solid waste. Slightly less than a quarter of respondents mention that their waste is collected. As many as 16% admit that they dump their waste randomly outdoors. Just 6% sort their waste inside the home. Collector (company, natour, municipality)

22% 62%

Waste is disposed in municipal containers Waste is dumped randomly (spread between tents/houses)

3% 13% 6%

Waste is dumped randomly in closed bags (spread between tents/houses) – Waste is sorted at source (i.e. inside the home)

Table 5.15: Disposal of solid waste in Lebanese households The 6%, who represent 579 of the total 5,100, of Lebanese respondents who said that they sort their waste inside the home were asked according to which categories they sort their solid waste. The most frequently mentioned categories are ‘organic’ and ‘recyclable materials’.

102

24% 63% 35% 64% Non-recycable

Recyclable materials

Non-organic

Organic

Table 5.16: Categories in which solid waste is sorted out in for Lebanese households who state to sort their waste at the source Sanitation More than half of the Lebanese respondents answered ‘yes’, while 45% said ‘no’, upon being asked whether they share a toilet/latrine with other families or individuals. Almost everyone, 98%, who shares a toilet/latrine with others reports that it is clean, while 2% state that it is somewhat clean.

5.3.3. Syrians registered with UNHCR domain Water 48% of respondents in the registered Syrian domain use bottled water as the primary source of drinking water and roughly a third uses piped water. For the rest, the main source of drinking water is either a well or spring and water delivered by truck. Data from FGDs indicates that procuring good quality water is a financial burden for Syrian refugees in Lebanon. In all domains, a clear division is made between drinking water and water for general usage. Syrian respondents in FGDs mentioned that the water quality in Lebanon is lower than what they were used to in Syria. “In Syria, we used to drink tap water. Here, Lebanese tell us not to drink tap water, they say it is not good. We buy water from the water truck. It’s not the cleanest water, but we have no other choice.” Syrian mother, FGD in Mount Lebanon, May 2017

103

Piped water supply (local well managed by municipality) Unprotected well/spring

3% 4%

Tanker-Trucking

6%


12% 13%

Piped water supply (Local well managed by WE) Piped water supply (WE network)

15% 48%

Bottled water/ fountain gallon water

Table 5.17: Main source of drinking water for households of Syrians registered with UNHCR Hygiene 87% of registered Syrian respondents state that they use bar soap when handwashing, 12% liquid soap and 1% water only. When asked about the most important times to wash hands during the day, male and female respondents provided varied responses. The most frequent response of registered female Syrian respondents was after eating at 80%, followed by before feeding the baby or child at 56%. Registered male Syrian respondents’ most frequent response was when necessary at 75% followed by when returning home from outside at 61%. Syrian participants in FGDs had a solid understanding of hygiene, but practical barriers such as lack of financial means or lack of infrastructure prevented them from adhering to appropriate hygiene practices.

25%

80%

44%

50% 47% 49%

Female

39%

56% 75%

20% Male

44%

56% 50% 53% 51% 61%

When necessary

After eating


After changing baby/child diapers

Before eating

Before feeding the baby/child


When returning to house from work/ from outside

Table 5.18: The most important times to wash hands during the day as cited by Syrian refugees registered with UNHCR In FGDs, Syrian respondents mentioned that the purchase of hygiene and cleaning products places a heavy financial burden on them and that it therefore is a barrier to appropriate hygiene practices. Dishwashing liquid, laundry detergent, floor-cleaning products, shampoo, but also menstrual pads and other items, add considerably to household expenditures. Overall, qualitative data show a clear

104 difference between gender roles: while it is the man’s role to make sure that the household has water, it is the woman’s role to ensure cleanliness and hygiene inside the home. Syrian women living in collective shelters in Nabatieh, who participated in an FGD, highlighted the challenges of performing their role as duty-bearers, since a lack of financial means meant that they cannot always ensure their children’s hygiene. “Sometimes I see that my child is very dirty and I look away. I have to buy water to shower him.” Syrian mother, FGD in Nabatieh, June 2017

hygienic bathrooms

46% 49% 47% 47% 48% 49% 43% 43%

Female

proper/ cleaning/washing vegetables before cooking/eating proper cooking of food Use of treated/ properly stored water for cooking Drinking treated water

54% 51% 53% 53% 52% 51% 57% 57%

Male

hand-washing after cleaning children/ disposal of diapers hand-washing after using the bathroom hand-washing before eating

Table 5.19: Syrian respondents registered with UNHCR citing the most important ways to prevent disease transmission amongst people Solid waste Food scraps, plastic and paper are the most common types of solid waste in the households of registered Syrians. The percentages for the registered Syrian domain are similar to those for the Lebanese domain. The only notable difference is that the percentage of registered Syrians who identify cans as a common type of solid waste is almost twice that of Lebanese (19% for registered Syrians; 10% for Lebanese).

19% 8% 42% 71% 58% Cans

Glass

Papers

Food scraps

Plastic

Table 5.20: The two most common types of solid wastes in households of Syrian refugees registered with UNHCR

105

When asked how they usually dispose of solid waste, a large majority of respondents in the registered Syrian domain say that they do so in municipal containers. If one adds the 16% that report that their solid waste is collected, as many as 91% of the respondents can dispose of their solid waste in an organized fashion. At the same time, 14% say that they dispose of solid waste themselves, either by dumping it randomly or by burning it. Just one percent sort their solid waste at home. “I throw the trash away in closed bags in the municipal containers. I do not sort as it gets mixed up in the container anyway.” Syrian mother, FGD in Mount Lebanon, May 2017

Waste is burned

3%

Collector (company, natour, municipality)

16% 75% 5% 6% 1%

Waste is disposed in municipal containers Waste is dumped randomly (spread between tents/houses) Waste is dumped randomly in closed bags (spread between tents/houses) – Waste is sorted at source (i.e. inside the home)

Table 5.21: Disposal of solid waste in households of Syrian refugees registered with UNHCR The one percent of respondents in the registered Syrian domain, which equals 16 respondents, who sort solid waste in their home tend to sort waste into organic matter at 88%, non-organic matter at 50%, recyclable materials at 38%. Sanitation Almost two thirds, or 63%, of respondents in the registered Syrian domain do not share their toilet or latrine with other families or individuals, while 37% do. One percent state not having a toilet or latrine. Of those 37% who share a toilet or latrine with others, 54% reported that it is clean, 35% said that it is somewhat clean and 11% that it is not clean.

5.3.4. Syrians in ISs domain Water The main source of drinking water for members of households in the Syrians in ISs domain is trucked water at 46%. Bottled water is the second most common source of drinking water at 22%, followed by protected well water at 15%. Qualitative data validates these findings: ISs who are supported by UNICEF and NGO partners regularly receive trucked water. This service provision is costly as well as time- and energy-consuming. “You know the water is good from the taste of the tea.” Syrian girl, FGD in an IS in the Bekaa, May 2017

106

Rain water (underground reservoir)

2%


2%


3%


8% 15%



46% Tanker-Trucking

Table 5.22: Main source of drinking water for households of Syrians in ISs

Hygiene 88% of Syrian respondents living in ISs state using bar soap for handwashing, while 11% use liquid soap and 1% use water only. When asked about the most important times to wash hands during the day, female respondents in ISs have a much higher level of knowledge than male respondents, pointing towards a strict gender discrepancy. This can partly be due to women performing most if not all caretaking activities, including cooking, cleaning and ensuring children’s hygiene.

86% 84%

Female

80% 9%

91%

90% 88%

14%

16% 10% 12% 20%

Male



Before eating




Table 5.23: The most important times to wash hands during the day as cited by Syrians living in ISs Hygiene promotion activities by NGOs, that have been going on for several years, in most part target women living in ISs since most men are out during the day. Th KAP Study data show that the hygiene promotion information is not passed on from women to men in the household. Critically, while knowledge on appropriate hygiene practices is indispensable, the lack of gender-equal knowledge sharing might reinforce the lack of gender-equal burden-sharing.

107 “It is important to be clean, so to not get lice or diseases and not to smell.” Syrian girls, FGD in an IS in the Bekaa, May 2017

hygienic bathrooms

91% 87% 81% 83% 89% 87% 82% 82%

Female

proper cooking of food Use of treated/ properly stored water for cooking Drinking treated water

9% 13% 19% 18% 11% 13% 18% 18%

Male

proper/ cleaning/washing vegetables before cooking/eating

hand-washing after cleaning children/ disposal of diapers hand-washing after using the bathroom hand-washing before eating

Table 5.24: Syrian respondents living in ISs citing the most important ways to prevent disease transmission amongst people A similar gender discrepancy can be noted for knowledge on the most important ways to prevent disease transmission. Men’s limited response rate means that they might unknowingly increase the risk of passing on diseases due to lack of knowledge. Men’s lack of knowledge might persist since most disease prevention campaigns target caretaking activities such as cleaning and cooking, which respondents say is the responsibility of girls and women. Interestingly, female respondents in ISs cite hygienic bathrooms most frequently as a way to prevent disease transmission. Qualitative data from FGDs with women living in ISs in Akkar and the Bekaa highlight the challenge of sharing latrines and the difficulties of keeping them clean because of the high number of users. Solid waste As in all other domains, the most common types of solid waste in Syrian in ISs households are food scraps at 81%, plastic and paper at 53%. Only in the Syrian in ISs domain are diapers mentioned as a common type of waste.

4% 2% 6% 2% 53% 81% 53% Diapers

Cloth

Cans

Glass

Papers

Food scraps

Plastic

Table 5.25: The two most common types of solid waste in households of Syrians living in ISs

108 76% of Syrian respondents in ISs dispose of solid waste mainly by putting it in municipal containers. 13% of respondents report that dispose of solid waste by burning it. Just as many state that they dump waste randomly between tents. “All the garbage inside the tent is handled by the women in the family and the garbage outside is handled by men and boys.” Syrian boy, FGD in Baalbek-Hermel, June 2017

Waste is burned

13%

Collector (company, natour, municipality)

2% 76%

Waste is disposed in municipal containers Waste is dumped randomly (spread between tents/houses)

5% 8%

Waste is dumped randomly in closed bags (spread between tents/houses) –

Table 5.26: Disposal of solid waste in households of Syrians living in ISs Sanitation The quota of Syrian respondents in ISs who share their toilet or latrine with other families or individuals is 47%. 51% do not share their toilet or latrine with others, while 2% state not having access to toilets or latrines. Slightly less Syrians in ISs share their toilet or latrine with others than respondents in the other Syrian domain.

2% 47% 51% No toilets / latrines

Yes

No

Table 5.27: Syrian households in ISs who share their toilet or latrine with other families or individuals “Every 6 to 8 families share one bathroom for men and one for women, with toilet and shower in the same place. Sometimes we also shower inside the tent.” Syrian mother, FGD in Akkar, June 2017 Of the 47% of households who do share their toilet or latrine with others, just a quarter say that it is clean. The rest define the shared toilet/latrine as somewhat clean at 48% or not clean at all at 27%. There are variations in access to toilets and bathrooms in ISs. In a FGD with Syrian girls living in an IS in the Bekaa, every tent had its own bathroom or toilet. Other ISs visited in the Bekaa however had

109 one bathroom and toilet between several tents, meaning that several households made use of it. Women and girls mentioned not feeling comfortable with this arrangement, especially when having their period, and mentioned the problem of overcrowding especially during prayer time for abolition washing.

25% 27% 48% Clean

Not clean

Somewhat clean

Table 5.28: Hygienic condition of toilet or latrine as reported by Syrians living in ISs who share their bathroom with other families or individuals

5.3.5. Palestine refugees domain Water More than half of the Palestine refugee respondents, or 59%, report that members of their household use bottled water as their main source of drinking water. 20% have access to piped water as their main source of drinking water and as many as 11% say that they get their drinking water from underground reservoirs of rain water. As with all domains, drinking water is differentiated from water for general usage. Data from FGDs shows that water provided by UNRWA is not perceived as being of good quality and Palestine refugees often need to pay to procure water. “UNRWA is the main source of water in the camp, but it is salty water and has a foul smell. We mainly use it for cleaning the house or showering but is not suitable at all for cooking and drinking.” Palestine refugee mother, FGD in Nahr el Bared camp in the North, May 2017


2%

Tanker-Trucking

2%

Piped water supply (local well managed by municipality)

5%

Rain water (underground reservoir)

11% 20%



Table 5.29: Main source of drinking water for households of Palestine refugees

110

Hygiene For handwashing, 61% of Palestine refugees use bar soap, 38% liquid soap and 1% use only water. When asked about the most important times to wash hands during the day, female Palestine refugee respondents had more knowledge than male respondents, indicating a higher level of female respondents’ knowledge and awareness of, and responsibility for, the hygiene of household members.

Female

49% 41% 40% 38% 44% 43%

Male

59% 60% 62% 56% 57%

51%



Before eating




Table 5.30: The most important times to wash hands during the day as cited by Palestine refugees When asked about prevention of diseases, female respondents again provided more answers than male respondents. Levels of knowledge for Palestine refugees are comparable to those in the Lebanese domain, as results are similar. “The mother is the main person responsible for the cleanliness and hygiene of the children.” Palestine refugee mother, FGD in the North, May 2017

hygienic bathrooms

Female

Male

63% 62% 62% 59% 56% 52% 56% 55% 37% 38% 38% 41% 44% 48% 44% 45%

proper/ cleaning/washing vegetables before cooking/eating proper cooking of food Use of treated/ properly stored water for cooking Drinking treated water hand-washing after cleaning children/ disposal of diapers hand-washing after using the bathroom hand-washing before eating

111 Table 5.31: Palestine refugees citing the most important ways to prevent disease transmission amongst people

Solid waste Almost 90% of respondents in the Palestine refugees domain name food scraps as the most common type of solid waste in their household, with plastic and paper in second and third place, at 59% and 33% respectively.

9% 9% 33% 89% 59% Cans

Glass

Papers

Food scraps

Plastic

Table 5.32: The two most common types of solid wastes in households of Palestine refugees When asked how they usually dispose of solid waste, 42% answer that it is collected. This is the highest number for any domain. Many respondents dispose the waste in municipal containers. And an alarming 27% say that they dump their solid waste between tents/houses. “I am not satisfied with the solid garbage disposal in my community. I am not happy the way garbage is collected and burned which is causing diseases.” Palestine refugee mother, Nahr el Bared camp in the North, May 2017

Waste is re-used

4%

Waste is burned

1%

42% 34% 2% 25% 15%

Collector (company, natour, municipality) Waste is disposed in municipal containers Waste is dumped randomly (spread between tents/houses) Waste is dumped randomly in closed bags (spread between tents/houses) – Waste is sorted at source (i.e. inside the home)

Table 5.33: Disposal of solid waste in households of Palestine refugees

112 Of those 15%, or, in total numbers, 65, of Palestine refugee respondents who sort waste at the source, that is, in their home, 79% sort out organic materials and 19% also sort out recyclable materials.

5% 19% 2% 79% Non-recycable

Recyclable materials

Non-organic

Organic

Table 5.34: Categories into which solid waste is sorted in Palestine refugee households that state that they sort their waste at the source Sanitation A vast majority of respondents or 85% in the Palestine refugee domain does not share toilets or latrines with other families or individuals. Just 14% of respondents do and 2% state that they do not have a toilet or latrine. Of the respondents who share a toilet or latrine with other families or individuals, a majority, 71%, say that the toilet or latrine is clean, while 14% believe it is somewhat clean and another 14% think that it is not clean.

Bibliography Abdulrahim, Sawsan and Jana Harb. 2015. Profiling the vulnerability of Palestine refugees from Syria living in Lebanon. Beirut: UNRWA. Attieh, Elie et al. 2016. ‘Feminine hygiene practices among female patients and nurses in Lebanon’. Reproductive Health 13: 59. https://doi-org.proxy.mah.se/10.1186/s12978-016-0182-4. Accessed 25 September 2017. Government of Lebanon and United Nations. 2017. Lebanon Crisis Response Plan 2017-2020. Beirut: Government of Lebanon and United Nations. Ministry of Environment Lebanon. 2001. State of the environment report 2001. http://www.moe.gov.lb/The-Ministry/Reports/State-Of-the-Environment-Report2001.aspx?lang=en-us. Accessed 26 September 2017. Noone, Ciara. 2016. Neighbourhood profiles: Shelter condition, access to public services and hygiene behaviours. Beirut: ACTED.

113 UNHCR, UNICEF, and WFP. 2016. Vulnerability assessment of Syrian refugees in Lebanon 2016. Beirut: UNHCR, UNICEF and WFP. UNICEF. 2017a. ‘Hygiene’. Accessed 26 September 2017. https://www.unicef.org/wash/3942_4457.html. UNICEF. 2017b. ‘Water, sanitation and hygiene’. Accessed 26 September 2017. www.unicef.org/wash/ World Vision International. 2014. ‘Syrian refugee parents defeat hygiene barriers’. http://www.wvi.org/lebanon/article/syrian-refugee-parents-defeat-hygiene-barriers.

114

6. EDUCATION 6.1. Situation analysis All children have the right to quality education that is relevant to their present and future lives. Providing access to education is among UNICEF's core objectives worldwide. Central to UNICEF’s education programming is a focus on early learning, equal access, continuation of education in emergencies, quality, partnerships, and system strengthening.46

6.1.1 Education sector response Lebanon is home to more than 1.23 million children in need of educational support.47 The combined efforts of the Lebanese government, UN agencies, and NGOs aim to enrol 543,616 (or 44%) of these children in formal education.48 The focus of the response has been on enrolling displaced children in Lebanese public schools and on strengthening the public education system. Increasing numbers of public schools have opened their doors for refugee children during afternoon shifts, usually referred to as ‘second shifts’. While 88 public schools hosted second shifts in 2013-2014 this number increased to 313 during the 2016-2017 schoolyear. Second shifts are accessible for non-Lebanese students only and implement a condensed version of the official Lebanese curriculum. Palestine refugee children (both PRL and PRS), in turn, are enrolled in UNRWA schools. Despite concerted efforts of MEHE, UN agencies, and NGOs (as demarcated in the RACE I and II strategies), 48% of Syrian refugee children aged 6-14 and 84% of Syrian refugee children aged 15-17 remain out of formal school,49 alongside 42% of PRS children.50 Out-of-school rates are highest among secondary school-aged children (15-17 years) of whom only 16% is currently enrolled in certified education (see also table 1).51 The LCRP 2017-2020 lists poverty as a key barrier to accessing education for Lebanese children. In addition to poverty, refugee families report residency rules and negative perceptions of the value of education as reasons for non-attendance. Another source points at early marriage and working children as key coping strategies employed by families, both of which prevent children from accessing or completing their education.52

46

UNICEF 2017.

47

Government of Lebanon and United Nations. 2017: 47.

48

Ibid.

49

UNHCR, UNICEF, and WFP 2016:27, 28.

50

Abdulrahim and Harb 2015. N.B.: Tables are not disaggregated according to the domains used in the KAP Study. 51

UNICEF, OCHA, and REACH 2015: 28.

52

Government of Lebanon, and United Nations. 2017: 48.

115

Table 6.1: % of out-of-school children per governorate53 Aside from formal pathways (pre-primary, primary, secondary education, or TVET), MEHE has established several non-formal education (NFE) pathways in an attempt to ease specific barriers to accessing certified education (table 2). Community-based and regular Early Childhood Education (ECE) prepare children aged 3-5 for enrolment in schooling. Basic Literacy and Numeracy (BLN) as well as Accelerated Learning Programs (ALP) support children who do not qualify for entry into formal education.

53

UNHCR, UNICEF, and WFP 2016: 29.

116

Table 6.2: NFE pathways in Lebanon54

6.1.2 Baseline indicators Knowledge of caregivers of formal and non-formal pathways to education and what that means in practice In order to gain better insight into caregivers’ knowledge and choice of education pathways, the first indicator assessed under education is knowledge of caregivers of formal and non-formal pathways to education and what that means in practice: which pathway are they more likely to choose for their child. Little is known about caregivers’ knowledge of formal and non-formal education pathways, and the likeliness they send their children to either of them. An earlier study by UNICEF, OCHA and REACH revealed a lack of knowledge and ‘confusion’ among displaced communities, and to a lesser degree among host communities, which is likely to prevent children from accessing available pathways.55 Attitudes towards girls’ participation in education and the practice taking place as a result of the attitude Detailed or representative studies of perceptions towards girls’ education are scarce or non-existent. A study by Human Rights Watch found that Syrian parents are more likely to keep older girls home due to safety concerns, including fears of (sexual) harassment.56 Regardless, REACH and UNHCR established that the majority of Syrian caregivers would like to send their children (both boys and girls) to school.57

54

Government of Lebanon and United Nations. 2017: 52.

55

UNICEF, OCHA, and REACH 2015.

56

Ibid.

57

REACH and UNHCR. 2014.

117 Syrian caregivers consider the decision to withdraw their children from school as ‘difficult and unfortunate’.58 The REACH and UNHCR findings were not disaggregated by residential conditions. As for Palestine refugee children, girls are less likely than boys to complete their primary education; however, 30.3% of girls hold a secondary or higher diploma as opposed to 28.7% of PRS boys. ‘There are no noticeable gender differences in school enrolment at young ages. Between the ages of 12 and 17, however, a larger proportion of girls are currently enroled compared to boys. […] [Boys] as young as 12 years of age begin to drop out of school at a higher rate compared to girls’. 59 These findings pertain to PRS, not to Palestine refugee children in general. Perceptions of quality of education in public schools and regulated NFE programs The third KAP indicator assessed for education is: perceptions of quality of education in public schools and regulated NFE programs (disaggregated by type of NFE program) in relation to actual practices of caregivers sending and retaining their children in school. The third dilemma targeted by this study relates to perceptions of quality in formal and NFE and how these perceptions shape Syrian caregivers’ choice to prioritize education over work and marriage. Non-formal programs, are perceived as offering varying quality. ‘Some NGOs run robust programs and hire teachers to follow a set curriculum, but others do not’.60 Studies prior to the current KAP Study show that poor quality is given as one of the reasons why caregivers might withdraw their children from education.61 Data on perceived quality of education in UNRWA schools prove hard to find, and there is a need to further understand the perceptions of quality among various vulnerable groups in Lebanon and to establish how this defines their decisions with regard to enrolment in formal or nonformal education.

6.2. Qualitative findings overview 6.2.1. Supply and demand of services The education indicators for the KAP Study refer to the utilization of formal and informal education pathways, girls’ enrolment in education, and the quality of education. As indicated above, supply in the education sector comprises both formal and non-formal pathways, alongside ‘illegal’ or uncertified schools which neither follow MEHE-endorsed curricula nor abide by its regulations. Formal education Public schools are at the forefront of the education response to the crisis. Aside from enrolling refugee students in morning shifts, the MEHE requests many of its public primary schools to operate additional ‘second shifts’ during afternoon hours to cater to non-Lebanese students. The number of public schools operating second shifts has increased from 88 during the 2013-2014 schoolyear to 313 in 20162017.62

58

Oxfam and Merits Partnership 2015.

59

Abdulrahim and Harb 2015.

60

Ibid.

61

Oxfam and Merits Partnership 2015.

62

Ministry of Education and Higher Education 2017.

118 Concerns from Lebanese parents about the enrolment of Syrian students in public schools resulted in 10,000 Lebanese students withdrawing from public schools63 but statistics show that enrolment levels are back at pre-crisis levels.64 MEHE has waived documentation requirements65 and fees for all public school students and provides textbooks free of charge so as to minimise the barriers to enrolment. Also, it is now deploying psychosocial and health counsellors to second shifts as well as community liaison volunteers.66 Aside from primary schools, MEHE also opens public secondary, vocational, and technical schools to non-Lebanese students. Close to 37,000 Palestine refugee students are enrolled in one of the 67 UNRWA schools across the country, three of which also operate a second shift. UNRWA schools teach the Lebanese curriculum rather successfully, its students achieving higher average results than their peers in Lebanese public schools.67 For adolescents and youth UNRWA also operates the Siblin training centre which offers accredited vocational and technical courses.68 NFE In order to complement formal education pathways, MEHE has launched a range of regulated nonformal education opportunities for non-Lebanese children. Those between 3 and 5 years can enrol in community-based early childhood education (ECE) or those turning 5 years before September of that academic year MEHE preparatory ECE in public schools. Children between 7 and 14 years who have missed out on schooling can access MEHE’s Accelerated Learning Programme (ALP) to prepare for enrolling in formal education. Those between 10 and 14 years with no prior schooling can access Basic Literacy and Numeracy (BLN) track in case they have learning gaps too substantial to allow for a return to formal education. Children and young people between 15 and 20 years can access an ALP programme, sit for Brevet exams, or benefit from BLN training. Barriers to and drivers of accessing education Despite the manifold formal and non-formal education pathways, 48% of primary school-aged and 84% of secondary school-aged Syrian refugee children remain out of school.69 Out-of-school rates vary considerably across governorates. A 2016 vulnerability assessment (UNHCR, UNICEF, and WFP 2016) identifies key demand-related barriers including the indirect ‘cost of education, child labour, child marriage, the need to stay at home, cultural reasons and transportation costs’. The same study lists supply-side barriers such as schools preventing enrolment, lack of nearby schools, lack of space in schools, school-based violence, and difficulties pertaining to language or curriculum.70 Many of these barriers were confirmed in the KIIs that were conducted for the KAP Study. A school principal noted that drop-out rates are highest between grade 7 (age 12) and grade 9 (age 14).71 UNICEF confirmed that the needs for adolescents to contribute to income generation is pressing and a reason to leave or stay out of school.72 At the same time, a positive tendency was observed by UNICEF

63

KII with MEHE staff, 24 May 2017.

64

Ministry of Education and Higher Education 2017.

65

Although this is not always clear to school principals (KII with UNICEF South staff, 19 may 2017).

66

KII with MEHE staff, 24 May 2017.

67

KII with UNRWA staff, 6 June 2017.

68

KII with UNRWA staff, 6 June 2017. See also www.unrwa.org/tags/siblin-training-centre.

69

UNHCR, UNICEF, and WFP 2016:27, 28.

70

UNHCR, UNICEF, and WFP 2016.

71

KII with school principal Akkar, 17 May 2017.

72

KII with UNICEF BML staff, 23 March 2017

119 in Beirut and Mount Lebanon where ‘Syrian refugees have increasingly the perception of being a “right holder” but [UNICEF needs] to raise awareness that they have obligations as well: follow up on your children’s education and well-being, contribute to the area in which you are living, etc.’.73 The recruitment of qualified teachers proves challenging to school directors, given the fact that only a university degree is needed but no pedagogical or practical training.74 MEHE warns of schools putting pressure on teachers to teach both regular and second shifts.75 Concerns about ‘illegal’ schools were raised in KIIs. A public school principal noted how ‘Syrian schools’ operate outside the scope of MEHE, using the Syrian curriculum, employing Syrian teachers, and often providing financial aid on top of education. It was mentioned that families may send some of their children to Lebanese public schools and others to ‘Syrian’ schools.76 Certain informal settlements were said to be off-limits to NGOs and UN agencies with alternative organisations running education, healthcare, and other services.77 In other instances, the sheer amount of education information and messages delivered by national authorities or donors such as UNICEF means that there can be confusions on the ground. As a result, the messengers (NGOs) can sometimes lose credibility and even “look like liars.”78 The KAP Study baseline indicators give further insight into drivers of and barriers to accessing education.


Mount Lebanon

Akkar

North

Bekaa

BaalbekHermel

South

Nabatieh

Lebanese mothers

Syrian boys

Lebanese fathers

Syrian girls

Lebanese boys

Syrian fathers (IS)


Lebanese girls

Table 6.3: Education FGDs matrix Education is a critical topic that was mentioned in many FGDs. The qualitative data gathering focused mainly on gaging caregivers’ knowledge of formal and non-formal pathways to education, attitudes towards girls’ participation in education and perceptions of quality of education of the formal education system. For Lebanese and Syrians, data gathering was focused on Lebanese public schools while for Palestine refugees it focused on UNRWA schools. Four FGDs were held with children and four with caregivers to get a better insight into what they like and do not like at school. “Public schools need to be further developed. The quality is good but they need more support.” Lebanese mother, FGD in Beirut, May 2017 Overall, Lebanese respondents are well aware of formal pathways to education and the different options available for their children. The choice of sending children to either seem to be mostly based

73

KII with UNICEF BML staff, 5 May x2017

74

KII school principal Akkar, 17 May 2017.

75

KII MEHE staff, 24 May 2017.

76

KII school principal Akkar, 17 May 2017.

77

KII UNICEF Bekaa staff, 26 May 2017.

78

KII NGO representative in Bekaa, 31 May 2017.

120 on financial means, with private schools remaining the preferred option if income allows. The clear majority of Lebanese children enrol from KG and primary school onwards, however retention in school and successful completion remains an issue for many. Lebanese mothers in Beirut mention challenges pupils are facing in passing exams, including the Brevet exam, and therefore drop out. In Akkar and Baalbak-Hermel, Lebanese fathers state that it is not always possible for boys to continue their education as they start working or helping out in family businesses. Moreover, boys assume responsibilities early on that cannot wait until past university. “If possible, boys should continue their education. But that is not always possible and the boy may not have the necessary interest.” FGD in Lebanese father, BaalbakHermel, June 2017 Most Lebanese caregivers value education strongly, for both boys and girls. They are invested and involved in their children’s studies; fathers pick up their children from school and mothers help out with homework and attend parents school meetings. Lebanese children attend a variety of activities, although boys have more options for organised sport activities including scouts and sports. None of the Lebanese respondents in the FGDs were aware of any NFE programmes. Most Syrian caregivers living in urban areas are aware that their children can and should attend formal school. However, multiple challenges exist in relation to enrolment and retention in schools. Even though MEHE waived all documents for registration, some parents have stated that their children were not accepted in school because they have missed too many years of schooling, did not have any identification papers or because the school had no more space to accommodate new students. Syrian caregivers who participated in FGDs vaguely knew of NFE programmes but had little information about them. Syrian caregivers living in ISs have more mixed opinions about the necessity of completing the education cycle. While some wish for their children to attend secondary school, others prioritise knowing how to read and write. “The children usually come and say that they have ‘school’ tomorrow but they are not learning anything [at the NGO education centre].” Syrian fathers, FGD in an IS in Baalbek-Hermel, June 2017 Several children in ISs also attend activities of NGO-run education centres. Syrian parents in ISs are aware that their children will not get a formal accredited certification, but lack of opportunities and a certain confusion of available NFE options make these activities more appealing to the parents. Palestine refugee caregivers on the other hand have no trouble accessing UNRWA schools for their children. While enrolment is not an issue for PRL and PRS, both face challenges in children’s, and especially boys’, school retention. Palestine refugee mothers are primarily responsible for following up on their children’s educational achievement. Difficulties in passing important exams, especially the Brevet, represent an issue primarily for Syrians, but also for PRS and some Lebanese and PRL. Palestine refugee mothers with children with disabilities preferred the remedial education offered inside UNRWA schools to the official curriculum. In principle, most respondents believed that girls and boys should participate equally in education. Arguments justifying girls’ education rely on the benefits this brings to their future family and children, but also to girls’ empowerment. Lebanese, Syrian and Palestine refugee respondents stressed that education increases marriage chances for girls, as they will be able to support children in their future education and their husband through an additional income. While education represents a girl’s safety net, in practice marriage is prioritised and fathers as well as husbands do play a role in encouraging or permitting girls and women to work or not.

121

“I did not register my children until recently because could not afford it. I am not sure I can afford to register them for the next school year.” Syrian mother, South, June 2017 Perceptions of quality of education differ within domains. A number of Lebanese, Syrian and Palestine refugee respondents are satisfied with Lebanese public schools and UNRWA schools respectively, while others perceive the quality of education to have deteriorated over the last years. Lebanese caregivers cite shortcomings in the school governance and infrastructure, the relative lack of accountability of teachers, and protection issues including corporal punishment as challenges to the quality of the public education system. Syrian respondents’ perception of quality of education varies, however most are facing challenges related to corporal punishment inside schools, transport to and from school as well as financial difficulties in keeping children enrolled. “There are no issues to enrolling children into school. The issues are inside the school: the school system demotivates children early on instead of supporting them.” Palestine refugee mother, FGD in the South, June 2017 The need for boys to earn an income and support the family was cited by both caregivers and Syrian boys themselves for instance in Akkar and Baalbak-Hermel, but remains an issue for all population groups. NGO-led education activities were perceived positively as providing children with basic educational knowledge and skills and as dealing respectfully with children. Palestine refugee caregivers highlight some shortcomings with the quality of UNRWA schools, including too many pupils in a classroom, demotivated teachers and continued practice of corporal punishment. Respondents especially criticise teaching methods in which teachers prioritise students with good grades. Last but not least, economic stagnation, lack of jobs and structural barriers to getting employed on the basis of nationality or identification are perceived to lower young people’s motivation to pursue formal education or lead them towards more vocational educational pathways.

6.3. Baseline indicators: Education 6.3.1. All domains Knowledge of caregivers of formal and non-formal pathways to education 67% of total caregivers interviewed knew how to enrol children in formal school. Awareness of formal education pathways is further discussed per domain below. 94% of all respondents reported no knowledge of non-formal education opportunities. Out of the 6% who are familiar with non-formal programmes, 66% are aware of remedial education or homework support and 29% of MEHE’s ALP programme.

% of caregivers who know how to enrol children in formal school

Lebanese residents

Registered Syrians with UNHCR


Palestine refugees in camps

Male

66%

54%

43%

93%

Female

67%

61%

36%

90%

Total

67%

57%

37%

91%

Totals

67%

122 % of caregivers who are aware of nonformal education activities and programmes

Male

NA

4%

0%

26%

Female

NA

7%

7%

27%

Total

NA

6%

6%

27%

6%

Table 6.4: Education indicators on caregivers’ knowledge on formal and non-formal education by domains, gender and in total

Attitudes towards and practices of girls’ participation in education

% of caregivers who believe girls should be in school until they graduate % of school-aged girls enrolled in formal education

Lebanese residents




Totals

96%

88%

82%

78%

93%

90%

60%

41%

89%

88%

6%

9%

12%

27%

9%

% of school-aged girls enrolled in non-formal education

Table 6.5: Education indicators on attitudes on and practices of girls’ participation by domains and in total

Attitudes towards quality of formal and non-formal education Of the 43% who refuse to enrol their children in public or UNRWA schools and the 2% who do not know if they would, 33% are ready to reconsider their negative attitude if schools would offer better quality of teaching, 28% if schools would cover transportation costs, 25% if schools would offer free education and 23% if schools would be of better quality. Of the 43% who refuse to enrol their children in public or UNRWA schools, 20% are not ready to reconsider their negative attitude. Lebanese residents % of caregivers who would never enrol their children in public or UNRWA schools

47%

Registered Syrians with UNHCR 26%

Syrians living in ISs 39%

Palestine refugees in camps 21%

Female

50%

28%

48%

8%

Total

49%

27%

46%

14%

Male

Totals

43%

Table 6.6: Education indicators on attitudes towards quality of services by domains, gender and in total

123

Of the 6% of total respondents who know about non-formal education, 78% would be interested in sending their children to non-formal education opportunities. 70% of those interested would also do so if activities were attended by mixed nationalities.

Children’s participation in formal and non-formal education Lebanese residents




Totals

93%

63%

43%

87%

83%

7%

10%

13%

28%

9%

% of school-aged children currently in formal education % of school-aged children currently enrolled in nonformal education

Table 6.7: Education indicators on children’s enrolment by domains and in total

44% of total number of children aged between 3 and eighteen who are currently enrolled in formal education attend primary school, 24% attend complementary school. 15% of children attend preschool and exactly as many attend secondary school. Primary (cycle 1&2) Complementary (cycle 3) Preschool Secondary BT, TS or LT BP University

44% 24% 15% 15% 1% 1% 1%

Table 6.8: Formal education pathways in which children from all domains are enrolled

Lack of scholarship money 33% Inappropriate age for education 30% Costs of textbooks and stationary 29% Transportation difficulties 23% Child does not like to attend school 17% Child has to work 17% Table 6.9: Reasons for non-attendance in school of children from all domains

59% of children between 3 and 18 who are currently out of school have never attended school in their life. For those who did go to school in the past, the following reasons are provided to explain drop-out: the child is unwilling to attend school (29%), the child needs to work (27%), the child does not understand the teachers (17%), the child received enough education (16%), or education is not necessary (15%).

124 84% of children enrolled in non-formal education participate in remedial classes (language and homework support). 11% are enrolled in MEHE’s ALP, 3% in CB-ECE, and 2% in BLN. Main reasons for not attending any non-formal education programmes include that NFE is not applicable (46%), lack of knowledge on existence of NFE (43%), lack of knowledge on how to register for NFE (40%), and no coverage for transportation costs (13%).

6.3.2. Lebanese domain Knowledge of caregivers of formal and non-formal pathways to education 67% of Lebanese caregivers know how to enrol children in formal education, but the degree of awareness varies by mohafaza. The highest knowledge levels on enrolment can be noted in Nabatieh at 87%, Akkar at 80%, North at 78% and South at 74%. The lowest knowledge levels on enrolment were found in Baalbek-Hermel at 54% and in Beirut at 56%. The knowledge of formal education pathways contrasts sharply with the 96% of Lebanese respondents reporting a lack of awareness of any NFE opportunities. Those few who are familiar with NFE mainly refer to remedial education opportunities and obtain details through family members. “This is the age of education. We are nothing without education. We would pay for our children to get an education.” Lebanese mother, FGD in Beirut, May 2017

26%

South

22%

North

78% 39%


74%

13%

87% 38%

Bekaa

62% 44%

Beirut

46%

Baalbek-El Hermel Akkar

61%

56% 54%

20% Do not know how to enroll

80% Know how to enroll

Table 6.10: Lebanese respondents who know how to enrol children in formal schools

Attitudes on and practices of girls’ participation in education 96% of Lebanese respondents believe that girls should be at school until they graduate, exhibiting an overwhelmingly positive attitude towards girls’ education. The most positive attitudes on this question can be noted in Mount Lebanon and the North at 98% and the lowest in the South at 90%.

125

Beirut

Bekaa and BaalbekHermel

Nabatieh

Mount Lebanon

North and Akkar

95%

97%

95%

98%

98%

South Total 90%

96%

Table 6.11: Lebanese respondents’ attitudes towards girls participation in education by mohafaza and in total This finding is validated by qualitative data. Lebanese caregivers placed strong emphasis on their daughters’ educational achievement, sometimes even more than for boys. Education was often cited as a girl’s ‘weapon’, affording her to have social power in the household, to be able to earn an income and to teach her children in the future. However, while attitudes were overall positive, practical challenges to girls’ educational attainment were also mentioned, including the importance of marriage, as well as protection issues if a girl would have to move to Beirut or abroad to advance her education.

3% 96%

By 18 years

Until they graduate from school

Table 6.12: Lebanese respondents’ attitudes on the age girls at which should leave school “Girls today can better support the finances of the family if they get an education and work.” Lebanese father, FGD in Akkar, June 2017 94% of school-aged Lebanese girls in respondent households are currently enrolled in private or public schools, vocational education, or a public kindergarten while 6% are enrolled in regulated non-formal education.79 Girls’ enrolment in formal education varied per mohafaza, with highest rates in Mount Lebanon at 94% and lowest in the North at 87%. Highest enrolment rates for girls in NFE were observed in Beirut at 17% and the lowest in the North at 2%.

79

Of an additional 5% of girls in Lebanese respondent families it was not known whether they attend NFE or not.

126

12%

South

88%

13%

North

87%

6%

Mount Lebanon

94%

9%

El Nabatieh

91%

Bekaa

11%

Beirut

11%

89% 89% Not enrolled

Enrolled

Table 6.13: Lebanese girls’ formal school attendance by mohafaza

Attitudes towards quality of formal and non-formal education Willingness to enrol children in public schools is limited among Lebanese respondents and depends on the mohafaza. The most positive attitudes were noted in Nabatieh at 42%, Mount Lebanon at 36% and the North at 35%. The most negative attitudes towards sending children to public schools were in Baalbek-Hermel at 61%, Beirut at 59% and Bekaa at 58%. Most children who are already enrolled in Lebanese public schools are in the South at 34% and Baalbek-Hermel at 25%. Even though MEHE have put in place Standard Operating Procedures (SOPs) to limit violence and corporal punishment, in the FGDs, Lebanese caregivers argued that shortcomings in public schools’ governance and infrastructure, the relative lack of accountability of teachers, and protection issues including corporal punishment constitute negative aspects of the public education system. South North Mount Lebanon

1% 31% 1%

Beirut

11%

52%

35% 1%

17%

46%

36% 3%

El Nabatieh Bekaa

34% 34%

8% 42%

%

47%

16%

58%

26% 3%

12%

59%

27%

Baalbek-El Hermel

25%

61%

15% 22%

Akkar

50%

28% Do not know

Already in Lebanese public school

No

Yes

Table 6.14: Lebanese caregivers who would send their children to Lebanese public schools by mohafaza

127

34% of Lebanese who are unwilling to send their children to public schools, or who do not know, stated that they could reconsider their negative attitude and would send their children to a public school if it would offer better teaching quality. 30% would reconsider if there was less violence, 24% if the quality of the school was better, and 20% if transportation costs were covered. 22% of respondents would under no circumstance consider enrolling their children in a public school. Of the 6% of Lebanese respondents who know about NFE opportunities, 65% would be interested in sending their children to NFE. 52% of those have no objections to children mixing with other nationalities during NFE activities. “In public schools there is no accountability of teachers and the school administration. If the principal is not effective, then the whole school is bad.” Lebanese father, FGD in Akkar, June 2016

Under no circumstances

22%

If I had no financial means to afford private schools Less violence

30% 3%

Teachers and staff are trustworthy Better school quality

12% 24% 34% 17%

Better teaching quality Free education

20% Transport costs covered

Table 6.15: Circumstances under which Lebanese caregivers would send their children to a public school Children’s participation in formal and non-formal education Within Lebanese respondents’ households, 94% of girls and 93% of boys who are of school age are currently enrolled in public kindergarten, or in private, public, or vocational schools. 7% of children in Lebanese households participate in NFE pathways. This shows that Lebanese caregivers are more likely to send their children to formal education. Lebanese children aged 3-18 years who are currently enrolled in education are at different educational levels. Around 40% of children are in cycle 1 and 2, 25% in cycle 3 and around 16% are in secondary school.

128

Female

1% 1% 1% 18% 25% 39% 15%

Male

2% 1% 14% 26% 42% 14% University Secondary Preschool

BT, TS or LT Complementary (cycle 3)

BP Primary (cycle 1&2)

Table 6.16: Educational level of children aged 3-18 years in the Lebanese domain by gender Reasons provided by Lebanese respondents for why their children are currently not enrolled in school vary with the place of residence. 80% of respondents in Baalbek-Hermel and 61% of respondents in the Bekaa state that children do not attend school because the child’s age is not appropriate for schooling. While this finding suggests that the population in these two mohafazat is quite young, qualitative data shows that boys and girls tend to drop out around grade 9, either before or after taking the Brevet, and therefore do not continue to secondary education. The other two reasons point towards worrying trends of children’s dissatisfaction with school and child labour. “My teacher is 64 years old, he does not understand or joke with us. I would prefer to have a younger teacher.” Lebanese boy, FGD in Bekaa, June 2017

129

El Nabatieh

40%

10%

18%

South

26% 24%

Beirut North Baalbek - El hermel Bekaa

41%

21% 24%

48%

16% 5%

4%

36% 31% 80%

13% 61%

12%

Mount Lebanon

13%

Akkar

13%

Age is not appropriate for school

50% 23% 49% 33% Child needs to work for a living Child does not like to go to school

Table 6.17: Reasons cited by Lebanese caregivers for why their children do not attend regular private or public school, a vocational course or public preschool Most children in the Lebanese domain who are currently out of school had attended school earlier but dropped out, with the highest drop-out rate being in Nabatieh and South at 76% and 75% respectively. The highest number of children who have never attended school are to be found in Baalbek-Hermel at 65% and in Bekaa at 58%. For those children who did attend school in the past, table 6.18 shows the main reasons for drop-out.

El Nabatieh South Beirut North

24%

76%

25%

75%

28%

72%

25%

75%

Baalbek - El hermel

65%

35%

Bekaa

43%

Mount Lebanon

31% 33%

Akkar

Has never attended school

58% 69% 67%

Has attended school in the past

Table 6.18: Drop-out rates for children in the Lebanese domain who are not currently attending regular private or public school, a vocational course or public preschool

130

19% 19%

El Nabatieh 13%

South

22%

%

36%

48%

17%

50%

18%

35%

6%

Mount Lebanon Akkar

42%

22%

North

Bekaa

27% 27% 25%

Beirut

Baalbek - El hermel

27%

25%

32% 34%

14%

Received education is enough

43% Child is unwilling to attend school

63%

Child needs to work

Table 6.19: Main reasons for drop-out among Lebanese children who had previously attended regular private or public school, a vocational course or public preschool 94% of Lebanese children enrolled in NFE take part in remedial education programmes such as homework or language support. Main reasons for not attending any NFE programme include a lack of awareness among Lebanese caregivers of what NFE is about (45%), the impression that NFE is not applicable (44%), and a lack of knowledge on how to register for NFE (41%).

6.3.3. Syrians registered with UNHCR domain Knowledge of caregivers of formal and non-formal pathways to education The awareness of registered Syrian caregivers on how to enrol their children in formal education varies per governorate, with the highest level of awareness in Akkar at 79% and in the North and Nabatieh at 72%. While knowledge levels are also relatively high in Beirut at 70%, in South at 61% and in Mount Lebanon at 60%, Bekaa and Baalbek-Hermel show a low level of awareness, with only 3841% of registered Syrian caregivers knowing how to enrol children. 94% of registered Syrian caregivers have no knowledge of NFE opportunities. Among the 6% who are aware of NFE opportunities, most know about the ALP (53%) or about remedial education (47%) and obtain details through NGOs or UN agencies. “My children are in a public school. The school is free, but I pay for stationary, extra activities, school trips, uniforms and school transportation. It costs me around LL 125,000 for every child. I am satisfied with the school.” Syrian father, FGD in South, June 2017

131

39%

South

61%

28%

North

72% 40%

Mount Lebanon

60%

28%

El Nabatieh

72%

Bekaa

62%

38% 30%

Beirut

70%

Baalbek-El Hermel

59%

41% 21%

Akkar

79%

Do not know how to enroll

Know how to enroll

Table 6.20: Syrian respondents registered with UNHCR who know how to enrol children in formal schools When asked whether they can enrol their children in a Lebanese public school without any documents, many Syrian caregivers believe that this is not possible, the percentage ranging from 36% in the South to 64% in Bekaa. The rate of caregivers who do believe that it is possible to enrol children without documents are 30% in the South, 28% in Nabatieh, 25% in the North and 27% in Akkar.

South

30%

North

Baalbek-El Hermel

48%

16%

El Nabatieh

Beirut

54%

25%

Mount Lebanon

Bekaa

36%

58%

28%

64%

7% 50%

17% 40%

14%

Akkar I cannot enrol my child without any documents

27%

50%

I can enrol my child without any documents

Table 6.21: Syrian caregivers registered with UNHCR by mohafaza who believe that they can enrol their child in a Lebanese public school without any documents

Attitudes on and practices of girls’ participation in education 88% of registered Syrian respondents believe that girls should be in school until they graduate. 6% think girls should be in school until they reach the age of 18, 3% until 14, 3% until 16, and 1% until 12 years. The lowest percentage of respondents who think that girls should be in school until they graduate was noted in Beirut at 73%; the highest percentage was found in the North and Akkar at 98%.

132 “If a girl is education, she can get better marriage proposals and if her husband leaves her she can work and support herself. But a girl does need to get married at the age of 18-22 years, or else she will not get a good match.” Syrian father, FGD in South, June 2017

Beirut


Mount Lebanon

North and Akkar

South and Nabatieh

Total

73%

83%

88%

98%

80%

88%

Table 6.22: Syrian respondents registered with UNHCR’s attitudes towards girls staying in school until graduation by region

1% 3% 3% 6%

88% By 12 years

By 16 years

By 14 years

By 18 years


Table 6.23: Syrian respondents registered with UNHCR’s attitudes on the age at which girls should leave school 64% of school-aged girls in registered Syrian households are currently enrolled in private or public schools, vocational education, or a public preschool, while 9% of girls regularly participate in nonformal education.80 Girls’ enrolment varies substantially per mohafaza, with highest enrolment rates in Beirut at 84% and lowest in the South at 53%. The highest enrolment rate in NFE was found in the South at 15% and the lowest in Beirut 0% at the time of data collection.

47%

South 35%

North

44%

Bekaa

58% 56% 16% Not enrolled

80

65% 42%

Mount Lebanon

Beirut

53%

84% Enrolled

Of an additional 2% of girls in urban Syrian refugee respondent families it was not known whether they attend NFE or not.

133 Table 6.24: Girls’ formal school attendance in the Syrians registered with UNHCR domain by mohafaza Attitudes towards quality of formal and non-formal education Compared to Lebanese respondents, registered Syrians are less resistant to enrolling their children in public schools. The most positive attitudes and willingness towards enrolling their children in Lebanese public schools was noted among registered Syrian caregivers in Akkar at 68%, in the North at 61% and in Beirut at 67%. Qualitative data from FGDs validate these findings, as Syrian mothers and fathers are keen to send their children to public school. However, this may be because they are used to public services, including public education, from Syria or because they do not have the financial means to afford semi-private or private schools.


1%

69%

4%

26%

1%

16%

1%

22% 2%

Baalbek-El Hermel

48%

30% 24% 14%

Do not know

30% 44% 43%

1%

Akkar

57%

11%

3%

Beirut

61%

19% 22%

El Nabatieh Bekaa

22%

28%

67% 47%

19%

Already in Lebanese public school

68% No

Yes

Table 6.25: Syrian caregivers registered with UNHCR who would send their children to Lebanese public schools by mohafaza Transportation costs remain a major barrier for enrolment of registered Syrian children in public schools. Covering transportation costs would compel 58% of caregivers to enrol them in public school. 47% of caregivers note that they would send their children to public schools if these were completely free. Registered Syrians also list improved quality of teaching (23%) and of the school in general (20%) as other drivers that would make them send their children to public schools. A decrease in violence is only mentioned by 6% of registered Syrian caregivers as motivator to enrol their children in a public school.

134


13%


8% 6%

Teachers and staff are trustworthy Better school quality

11% 20% 23%

Better teaching quality

47%

Free education

58%

Transport costs covered

Table 6.26: Circumstances under which Syrian caregivers registered with UNHCR would send their children to a Lebanese public school In FGDs, Syrian respondents’ perception of the quality of education varies, however most are facing challenges related to corporal punishment inside schools, transport to and from school as well as financial difficulties in keeping children enrolled. Moreover, of the 6% who know about NFE, 91% of respondents would be interested in sending their children to NFE opportunities, and 91% of those have no objections to children mixing with other nationalities during NFE activities.

Children’s participation in formal and non-formal education Within registered Syrian households, 64% of girls and 62% of boys of school age are currently enrolled in public preschools, or in private, public, and vocational schools. 10% of children participate in NFE pathways. 55% of children aged between 3 and 18 in Syrian households registered with UNHCR are currently enrolled in primary education (cycle 1 and 2). The number drops sharply for children enrolled in cycle 3 at 18-20% and in secondary school it is down to 7-10%.

10% 20%

Female

55% 15% 7% 18%

Male

56% 18%

Secondary


Primary (cycle 1&2)

Preschool

Table 6.27: Educational level of children aged 3-18 years in the Syrians registered with UNHCR domain by gender Even though MEHE provided free stationaries and text books to all enrolled children in public schools, registered Syrian caregivers of children who are not currently enrolled in education still perceive and cite text books and stationary as main financial burden. This might point towards a lack of knowledge by those Syrian caregivers that stationary and textbooks are provided free of charge to their children.

135 Differences can be noted at the mohafaza level. While financial reasons seem to be more prevalent in Baalbek-Hermel, in Bekaa and Mount Lebanon children are perceived to be either too young or too old to be in school. “My 11-year old son is studying and working in an aluminium factory on the side to support us.” Syrian mother, FGD in South, June 2017

20% 23%

South Beirut North

11% 67% 11% 9%

55% 31%

Baalbek - El hermel

40% 42% 35% 38%

Bekaa Mount Lebanon Akkar

51%

33% 9% 10%

Textbooks/stationary are not provided for free Age is not appropriate for school

51%

40% 40%

40% Scholarship money is not provided

Table 6.28: Reasons cited by Syrian caregivers registered with UNHCR for why their children do not attend regular private or public school, a vocational course or public preschool Of the school-aged children in registered Syrian households who are not currently enrolled in formal education, 90% in Bekaa have never attended school. The number for Baalbek-Hermel is 82%. While this could be due to the relatively high birth rate among Syrians, it also points towards a growing number of children in Lebanon who have never been to school.

136

South Beirut

60%

40%

North

74%

26%

Baalbek - El hermel Bekaa

56%

44%

82%

18%

90%

10%

Mount Lebanon

60%

40%

Akkar

61%

39% Has never attended school


Table 6.29: Drop-out rates for children in the Syrians registered with UNHCR domain who are not currently attending regular private or public school, a vocational course or public preschool

Among the registered Syrian domain, the three main drop-out reasons of children who did go to school in the past but had dropped out at the time of the KAP survey are that transportation is difficult, that the child does not like to go to school and that the child needs to work. Disparities can be found among mohafazat, with child labour cited as the main drop-out reason in Beirut compared to Mount Lebanon where the primary reason given for drop-out is that the child is not willing to go to school anymore. The issue of children not wanting to go to school and caregivers allowing the children to drop out points to issues of neglect.

20%

South

33%

25%

Beirut

50% 13% 13%

North Baalbek - El hermel Bekaa

10% 6% 9%

Mount Lebanon Akkar

13%

18% 17% 19% 19%

37%

25% 10%

Transportation is difficult (cost-distance)

30%

40% Child is unwilling to attend school

Child needs to work

Table 6.30: Main reasons for drop-out among children in the Syrians registered with UNHCR domain who had previously attended regular private or public school, a vocational course or public preschool Children in registered Syrian households who were enrolled in NFE predominantly attend remedial education at 73%, followed by ALP at 21% and CB-ECE at 4%. The main reasons for registered Syrian

137 refugee children not participating in NFE include that NFE is not considered applicable at 53% (meaning that the children are either too young or not enrolled in education), that there is a lack of knowledge on what NFE is about at 38% and on how to register for NFE at 36%, and no coverage of transportation costs at 17%.

4% 21% 73% Community-based Early Childhood Education (CBECE) Accelerated Learning Programme (ALP) Remedial education (homework and language support)

Table 6.31: Attendance of NFE programmes of children in the Syrians registered with UNHCR domain

6.3.4. Syrians in ISs domain Knowledge of caregivers of formal and non-formal pathways to education 63% of caregivers in ISs do not know how to enrol their children in Lebanese formal schools. When asked whether they can enrol their children in a Lebanese public school without any documents, only 13% believed that they could, compared to 47% who believed that they could not. Moreover, like Syrian registered refugees, 94% of residents of ISs are unaware of available NFE pathways. This data points towards a discrepancy between extensive outreach efforts and refugees in ISs’ level of knowledge. Of the few who know of the existence of NFE, 44% are unable to list any examples, while 31% refer to ALP, 19% refer to BLN and 19% refer to remedial education. Less than one percent of refugees in ISs are aware of MEHE’s CB-ECE programme. Information on NFE, if any, is obtained mainly through NGOs and UN agencies.

13% 39% 47% Yes

Don’t know

No

Table 6.32: Syrian caregivers registered with UNHCR who believe that can enrol their children in a Lebanese public school without any documents

Attitudes on and practices of girls’ participation in education 82% of Syrian respondents in urban settings believe that girls should be in school until they graduate. 5% think girls should be in school until they reach the age of 18, 5% until 14, 5% until 16, 2% until 12 years, and 1% until 10 years.

138

1% 2% 5% 5%

5% 82% By 10 years By 16 years By 18 years

By 12 years By 14 years Until they graduate from school

Table 6.33: Syrian respondents in ISs’ attitudes on the age at which girls should leave school 42% of school-aged Syrian girls residing in ISs are currently enrolled in private or public schools, vocational education, or a public kindergarten while 11% are enrolled in regulated non-formal education.81 Qualitative data from FGDs highlight the barriers girls living in ISs face to attending school. The barriers represent a mixture of attitudinal and practice barriers. In FGDs, some Syrian caregivers in ISs highlighted that education up to the Brevet (grade 9) is sufficient since girls should start preparing themselves for marriage. On the other hand, lack of transportation to and from the school is a real barrier for girls attending school, as Syrian caregivers in ISs stressed that harassment of young girls on their way to school represented a real protection risk.

Attitudes towards quality of formal and non-formal education 46% of Syrian caregivers in ISs is unwilling to enrol their children in Lebanese public schools. While 25% of children in Syrians in ISs households are already enrolled in public schools, another 25% would consider to send their children.

4% 25% 25% 46%

Do not know

Already in Lebanese public schools

Yes

No

Table 6.34: Syrian caregivers in ISs who would send their children to Lebanese public schools 79% of Syrian caregivers residing in ISs, who do not currently enrol their children in public schools, say they would do so if education would be completely free, 69% would do so if transportation costs were covered and 24% if the teaching quality improved. 75% of respondents would be interested in sending their children to NFE opportunities, 81% of whom have no objections to children mixing with other nationalities during NFE activities. 81

Of an additional 2% of girls in informal settlements it was not known whether they attend NFE or not.

139

4% 12% 2% 7% 24% 79% 69% Under no circumstances Teachers and staff are trustworthy Better teaching quality Transport costs covered

If I had no financial means to afford private schools Better school quality Free education

Table 6.35: Circumstances under which Syrian caregivers in ISs would send their children to Lebanese public school

Children’s participation in formal and non-formal education Within Syrian households living in ISs, 42% of girls and 45% of boys of school age are currently enrolled in public preschool, or in private, public, and vocational schools. 13% of children in Syrian households in ISs participate in NFE pathways, which is slightly more than among registered Syrians. 46% of Syrian girls and 52% of Syrian boys in ISs attend cycle 1 and 2 in school, while only 21% of girls and 17% of boys attend cycle 3. Twice as many Syrian boys in ISs (14%) attend secondary school than girls (7%). A number of children also attend educational activities provided by NGOs and other service providers. “My children go to an NGO centre sometimes. They are not learning anything, but seem to be only playing, not studying.” Syrian father, IS in Baalbek-Hermel, June 2017

Other Non-standard curriculum (such as NGO programmes, Syrian schools…) Secondary

14% 7% 21%

Female

46% 12%


9%

Primary (cycle 1&2)

14% 17%

Male

52% 8%

Preschool

Table 6.36: Educational level of children aged 3-18 years in the Syrians in ISs domain by gender

140 The three main reasons expressed by Syrian caregivers in ISs for why their children do not regularly attend formal education are that scholarship money is not provided (in other words, that education costs are not covered) at 35%, that the child is either too young or too old to attend school, also at 35%, and that school-related costs are not covered at 32%. The main barrier to children’s enrolment seems to be of financial nature.

32% 35% 35%

Textbooks/stationary are not provided for free

Age is not appropriate for school

Scholarship money is not provided

Table 6.37: Reasons cited by Syrian caregivers in ISs for why their children do not attend regular private or public school, a vocational course or public preschool Of the Syrian children in ISs who are not currently enrolled in formal education, 68% never went to school. The main reasons for drop-out of Syrian children living in ISs are the lack of a nearby school (20%) and lack of transportation (19%). Moreover, 18% of Syrian respondents in ISs state ‘the conflict in Syria’ as a reason for their children’s drop-outs, which refers to challenges of displacement and indicates that adaptating to life in Lebanon is difficult.

68% 32%

Has never attended school


Table 6.38: Drop-out rates for children in the Syrians in ISs domain who are not currently attending regular private or public school, a vocational course or public preschool Of the 13% of children in the Syrians in ISs domain who attend NFE programmes, 55% attend remedial education, 41% attend ALP and 4% CBECE. The main reasons for not attending any NFE include a lack of knowledge on how to register for NFE at 44%, lack of knowledge on what NFE is about at 40%, and no coverage for transportation costs at 28%.

141

4% 41% 55%

Community-based Early Childhood Education (CBECE) Accelerated Learning Programme (ALP) Remedial education (homework and language support)

Table 6.39: Syrian children in ISs attendance of NFE programmes

6.3.5. Palestine refugees domain Knowledge of caregivers of formal and non-formal pathways to education 91% of Palestine refugee caregivers say they know how to enrol their children in UNRWA schools. This finding is validated by qualitative data. Palestine refugees in FGDs state that enrolment of children into school is not an issue, it is the retainment around grades 7-9 that is problematic. Moreover, qualitative data point towards mothers taking on the task of enrolling children in schools. The awareness of NFE pathways is considerably larger among Palestine refugees than among Lebanese and Syrian respondents. 27% of Palestine refugee respondents know of NFE programmes. Of those, 72% refer to remedial education. Most information on NFE is obtained through family members.

Attitudes on and practices of girls’ participation in education 78% of Palestine refugee respondents believe that girls should be in school until they graduate. 19% think a girl should be in school until she reaches the age of 18, which could be considered an equivalent to finishing school. 2% of Palestine refugee respondents believe girls should be in school until the age of 16, and 1% until 14 years.

1% 2% 19% 78% By 14 years

By 16 years

By 18 years


Table 6.40: Palestine refugee respondents’ attitudes on the age at which girls should leave school 92% of school-aged girls in respondent households in Palestine camps are currently enrolled in UNRWA schools, vocational education or public preschool and 30% in non-formal education.82 In 82

Of an additional 6% of girls in the Palestine refugees domain it was not known whether they attend NFE or not.

142 FGDs, Palestine refugee caregivers stressed the importance of education, for both boys and girls. Female caregivers were especially vocal about girls’ education, highlighting that it would benefit the girls’ themselves as well as family members if they were educated. Caregivers argued that girls’ characteristics, such as being more quiet and studious, increased their chances to succeed in formal education compared to boys, who spend more time outdoors with friends and are keen to make an income as soon as possible. “Investing in girls’ education provides more results than investing in boys’ education.” Palestine refugee mother, FGD in the South, June 2017

Not enrolled

11%

Enrolled

89%

Table 6.41: Girls in Palestine refugee domain enrolled in UNRWA schools, vocational education or public preschool

Attitudes towards quality of formal and non-formal education Attitudes towards enrolment in UNRWA schools are positive with 56% of Palestine refugee caregivers expressing willingness to enrol their children in UNRWA schools and 23% already doing so. 69% of Palestine refugee caregivers who had not enrolled their children in UNRWA schools at the time of the survey, stated that they would reconsider their decision if transportation costs were covered, if education were completely free (64%), or if teaching quality improved (56%). Critically, since UNRWA schools are completely free of charge, it is likely that Palestine refugee respondents referred to school-related costs.

7% 14% 23% 56% Do not know

No

Already in UNRWA schools

Yes

Table 6.42: Palestine refugee caregivers who would send their children to UNRWA schools “Our children are strongly influenced by the issues in the camps. My son says to me: ‘Inshallah there will be a war so that we do not need to go to school.’” Palestine refugee mother, FGD in South, June 2017

143


8%


18% 10%

Teachers and staff are trustworthy

16%

Better school quality

20% 56%

Better teaching quality

64%

Free education

69%

Transport costs covered

Table 6.43: Circumstances under which Palestine refugee caregivers would send their children to UNRWA school Moreover, 95% of Palestine refugee respondents would be interested in sending their children to NFE opportunities, 89% of whom have no objections to children mixing with other nationalities during NFE activities.

Children’s participation in formal and non-formal education Within Palestine refugee households, 92% of girls and 83% of boys of school age are currently enrolled in UNRWA schools, vocational education, or public preschool. 28% of children in Palestine refugee households participate in NFE pathways, markedly more than in other domains. 40% of children in the Palestine refugee domain, who are currently enrolled in education, attend cycle 1 and 2 of formal education, while 24% attend cycle 3. Slightly more girls are enrolled in secondary education than boys at 17% compared to 13%.

Female

1% 1% 1%

17%

25%

40%

16% 1% Male

2% 2%

13%

23%

41%

18% University Secondary Preschool

BT, TS or LT Complementary (cycle 3)

BP Primary (cycle 1&2)

Table 6.44: Educational level of children aged 3-18 years in the Palestine refugee domain by gender

144 Of school-aged children in the Palestine refugee domain, who are not currently enrolled in formal education, respondents state that 40% do not have the appropriate age to attend school, 28% state that the child does not like to go to school, while another 28% believe that education is not necessary. The latter reason might refer to preschool but also to higher educational levels such as secondary school.

28% 28% 40% Education is not necessary Age is not appropriate for school

Child does not like to go to school

Table 6.45: Reasons cited by Palestine refugee caregivers for why their children do not attend regular private or public school, a vocational course or public preschool

76% of Palestine refugee children who are currently out of school were in school in the past. Caregivers cite several reasons for drop-out of Palestine refugee children: 36% are said to have dropped out because of the perceived lack of quality of UNRWA schools, 32% because of the need to work and 32% because the child does not understand the teachers. Of the total of 28% of Palestine refugee children who are enrolled in NFE programmes, 81% are enrolled in remedial education, 8% in CBECE, 6% in ALP and 5% in BLN.

5% 6% 8%

81% Basic Literacy and Numeracy (BLN) Accelerated Learning Programme (ALP) Community-based Early Childhood Education (CBECE) Remedial education (homework and language support)

Table 6.46: Palestine refugee children’s attendance of NFE programmes The main reasons for Palestine refugee children not taking part in NFE include a lack of knowledge on what NFE is about (39%), a lack of knowledge on how to register for NFE (36%), adverse security situation (15%) and no coverage for transportation costs (14%).

Bibliography

145 Abdulrahim, Sawsan and Jana Harb. 2015. Profiling the vulnerability of Palestine refugees from Syria living in Lebanon. Beirut: UNRWA. Government of Lebanon, and United Nations. 2017. Lebanon Crisis Response Plan 2017-2020. Beirut: Government of Lebanon and United Nations. Human Rights Watch. 2016. Preventing a lost generation: Lebanon. Growing up without an education. Barriers to education for Syrian refugee children in Lebanon. https://www.hrw.org/sites/default/files/report_pdf/lebanon0716_brochure_web.pdf. Accessed on 1 October 2017. Inter-agency Coordination Lebanon. 2017. June 2017 statistical dashboard. https://www.startpage.com/do/search. Accessed on 1 October 2017. Ministry of Education and Higher Education. 2017. R.A.C.E. Lebanon. Beirut: Project Management Unit, Ministry of Education and Higher Education. Oxfam and Merits Partnership. 2015. Self-protection and coping strategies of refugees from Syria and host communities in Lebanon. https://www.oxfam.org/sites/www.oxfam.org/files/file_attachments/rr-lebanon-refugeesprotection-300616-en.pdf. Accessed on 1 October 2017. REACH and UNHCR. 2014. Out of school children profiling: Barriers to education for Syrian children in Lebanon. Beirut: REACH and UNHCR. UNHCR, UNICEF, and WFP. 2016. Vulnerability assessment of Syrian refugees in Lebanon 2016. Beirut: UNHCR, UNICEF and WFP. UNICEF. 2017. Education. https://www.unicef.org/education/bege_61627.html. Accessed on 1 October 2017. UNICEF, OCHA, and REACH. 2015. Defining community vulnerabilities in Lebanon. Assessment report September 2014 – February 2015. Beirut: UNICEF, OCHA, and REACH.

146

7. CHILD PROTECTION 7.1. Situation analysis All children have the right to be protected from violence, exploitation and abuse. Some children are particularly at risk because of gender, socio-economic status, displacement or exposure to armed conflict. High protection needs are also associated with having a disability, absence of caregivers and social marginalisation.83 In collaboration with partners, UNICEF works on strengthening comprehensive child protection (CP) systems that incorporate human resources, laws, standards, governance, monitoring, and services.84

7.1.1. Child protection sector response CP is part of the overall protection sector in Lebanon, which focuses on addressing violence, exploitation, abuse against children as well as gender-based violence (GBV) including through strengthening referral pathways and ensuring access to services. More than 3.2 million persons are in need of protection, nearly 1.9 million of whom are targeted through programmes.85 Among the protection risks faced by children in Lebanon are the lack of birth registration, with 70% of around 100,000 Syrian refugee children born in Lebanon remaining unregistered86, and poverty, with 37% of vulnerable Lebanese, 71% Syrian refugees, and 65% of Palestine refugees living below the poverty line87. These factors compel households to revert to negative coping strategies such as child marriage, child labour and withdrawal from education, all of which leave children even more prone to exploitation, abuse and harassment.88 GBV rates are amplified by displacement and stress. Girls and women are disproportionally represented at 90% in reported incidents of GBV, which mostly involve physical violence, sexual violence, and forced or child marriage.89 This KAP Study focuses on the following seven child protection and GBV priorities: (1) Caregivers’ knowledge of the harmful consequences of child marriage; (2) Attitudes towards seeking child protection, SGVB, or other services for women and children; (3) Knowledge on protection risks and reporting mechanisms; (4) Attitude towards participation of minors in armed violence; (5) Caregivers’ knowledge of labour regulations in relation to working children; (6) Knowledge on positive discipline; (7) Perceptions of positive discipline.

7.1.2. Baseline indicators Knowledge on protection risks and reporting mechanisms

83

UNICEF 2017b. Ibid. 85 Government of Lebanon, and United Nations. 2017: 115. 86 Ibid: 117. 87 Ibid. 88 Ibid: 117-118. 89 Ibid: 119. 84

147 Low rates of support-seeking by survivors of CP violations and GBV not only relate to attitudes but also to a lack of knowledge of existing CP and GBV reporting mechanisms.90 Strikingly, 85% of community members surveyed as part of a vulnerability assessment were unaware of services for survivors of abuse, exploitation, and sexual violence.91 Low support-seeking trends are likely reinforced by limited awareness of protection risks. This CP indicator will be split into two separate indicators capturing knowledge of CP risks and associated reporting behaviour separately: % of targeted population who are knowledgeable on protection risks and % of targeted population who knows how to report CP or GBV violations. Knowledge of harmful consequences of child marriage “Marriage before the age of 18 is a fundamental violation of human rights.” 92 Among refugees from Syria, child marriage is often assumed to be a common coping mechanism,93 and is perceived as a means to “protect girls and better secure their future when faced with general insecurity, poverty, absence of male family members and uncertainty.”94 According to a recent UNFPA study, 24% of Syrian girls aged between 15 and 17 and living in the Bekaa valley are married, while 35% of women aged between 20 and 24 reported that they had married before reaching 18.95 Child marriage, however, has many potentially harmful implications, including health threats to the mother during pregnancy, at birth, and throughout the remainder of her life; threats to foetus life, increased risk of prematurity and low birth weight, as well as associated higher likelihood of developmental delays and disorders; threats to the girl’s psychosocial wellbeing; inability to access opportunities such as work and education; and increased risk of exposure to domestic violence.96 Feelings of abandonment, loss of support from parents and lack of access to resources to meet the demands of being a spouse and a mother may create additional stress for married girls.97 Moreover, Syrian refugee mothers mentioned the risk of ending up young as a widow because of the wars in Syria.98 Among the Lebanese population, child marriage has gradually decreased over time.99 1% of Lebanese girls gets married at 15 and 6% at 18 years.100 As for the Palestine refugee domain, UNRWA indicates a prevalence of child marriage in the North, which results in children dropping out or failing to enrol in education.101

90

Abla and Al-Masri 2014. UNICEF, OCHA, and REACH. 2015. 92 UNICEF 2017a. 93 UNHCR, UNICEF, and WFP 2016: 65. 94 Hassan et al. 2015. 95 See http://www.unfpa.org/news/new-study-finds-child-marriage-rising-among-most-vulnerable-syrianrefugees. 96 Listed consequences were identified by UNICEF Lebanon and reflected in the ToR for this study. 97 Hassan et al. 2015. 98 Spencer et al. 2015. 99 UNICEF 2016a. 100 UNICEF 2016b: 151. 101 Abdulrahim and Harb 2015: 30. 91

148 Recent campaigns102 highlight the need to address child marriage in Lebanon. To be able to do so, this KAP study defines the baseline against which the % of caregivers who are able to name at least 1 harmful consequence of child marriage will be measured. Positive attitude towards seeking CP, GBV and other services through MOSA and NGOs Reporting child protection offenses and seeking appropriate support remains a challenge for many survivors.103 Low reporting rates among Syrian youth, aged 15-24 years, are associated with hesitation to report GBV to case management agencies out of fear for further restrictions on movement, because it is perceived as a secondary problem104 or in response to practices of survivor blaming.105 Women and girls also report fearing to seek protection services due to a lack of residential documentation and fear of deportation.106 Moreover, access to services for GBV survivors is limited by distance to available services, limited availability of quality services and costs associated with care. A health access survey indicated that only 24-36% of Syrian refugees perceived care as affordable and accessible.107 In order to better understand attitudes towards seeking protection services, the indicator assessed is: % of individuals reporting positive attitude towards seeking CP, GBV, and other services for children and women through MOSA and NGOs. Attitudes of community members on participation of minors in armed violence Lebanon has signed but not ratified the CRC optional protocol on the involvement of children in armed conflict.108 The involvement of children in armed violence was a common feature across militias during the country’s civil wars (1975-1990) and there are signs of children’s continued involvement in armed violence, most notably in Palestine refugee camps.109 “Understanding children actively partaking in armed action requires acknowledging that this phenomenon is more complex than ‘abducted children being forced to fight’. These children are being pressured and recruited by other family and community members or are in need to earn money to support their families or for status and protection reasons. Children can also see themselves obliged to fight out of moral duty to protect their community.”110 So as to be able to assess attitudes towards children’s participation in armed violence, this indicator measures the % of community members answering “never” or any equivalent answer when asked in which circumstances the participation of minors in armed violence is justified. Caregivers’ knowledge of the minimum working age, working hours and types of work which are legally allowed in Lebanon for children UNICEF’s 2016 household baseline study details economic activity of children across population domains and governorates. In summary, it reveals that economic activity increases with age across domains. While 5% of Lebanese children aged 5-11 years are engaged in economic activity, 6% of

102

See for instance www.kafa.org.lb/kafa-news/113/raisetheage. Abla and Al-Masri 2014. 104 Ibid. 105 Spencer et al. 2015. 106 SGBV Working Group 2016. 107 Spencer et al. 2015. 108 UNICEF 2011: 1. 109 Coalition to Stop the Use of Child Soldiers 2007. 110 World Vision 2013. 103

149 children between 12 and 14 years and 11% of children aged 15-17 years are as well. Across ages, boys are twice as much engaged in work as girls.111 Based on data from 2016, 4% of Syrian refugee households resorted to putting children to work as a strategy to supplement family income. Figures were highest in Nabatieh at 7%, followed by Mount Lebanon at 5%, and Akkar and South Lebanon at 4% respectively.112 Table 7.1 shows that working children are mostly engaged in agricultural activities at 25%, services at 26%, and shops at 22%. Working adolescents are mostly involved in agriculture at 35% followed by services at 27% and construction at 17%.

Table 7.1: Type of labour by age group113 8.6% of Palestine refugee children between 5 and 14 years are involved in employment, with around twice as many boys at 10% as girls at 5% engaging in work.114 Children’s employment is substantially higher in rural areas at 10% compared to urban areas at 6.3%.115 On average Palestine refugee children work 26 hours per week.116 Reports show that economic activity negatively affects school attendance and completion.117 On top, work is associated with health, safety, and protection risks. Caregivers bear a key responsibility in protecting children against harmful consequences of work. To this end, knowledge of Lebanese labour law and its application to minors is critical. Key regulations relate to the minimum working age, which ranges between 14, 16 and 18 years depending on the type of work, maximum number of working hours, which is at 6 hours per day for children aged between 14 and 17 years, and the prohibited types 111

UNICEF 2016a: 270. UNHCR, UNICEF, and WFP 2016: 101. 113 Ibid: 56. 114 ILO and UCW 2014: 13. 115 Ibid: 14. 116 Ibid: 17. 117 ILO and UCW 2014; UNICEF 2016a. 112

150 of work (as defined in the Labour Code with regard to work that may compromise children’s safety, morals, and health).118 In order to gain better insight into caregivers’ knowledge of labour regulations that concern children, this indicator is: % of caregivers who have knowledge of the minimum working age, working hours and types of work which are allowed (legally) in Lebanon. Knowledge on positive discipline “Positive parenting practices involve providing guidance on how to handle emotions or conflicts in manners that encourage judgment and responsibility and preserve children's self-esteem, physical and psychological integrity and dignity.”119 Yet, 65% of Syrian refugee children, 57% of Lebanese children, and between 77% and 82% of Palestine refugee children between 1 and 14 years experienced violent discipline during the month preceding UNICEF’s 2016 household baseline study. Marked regional disparities in violent discipline were observed, with 26% of Lebanese children in Nabatieh reporting violent discipline compared to 85% in the North. Similarly, 38% of Syrian children experienced violent discipline in Mount Lebanon compared to 83% in the Bekaa, and 69% Palestine refugee children (PRL) reporting violent discipline in the Bekaa as opposed to 94% in Akkar.120 This indicates the need to advance knowledge of positive parenting (indicator 6) and support caregivers in putting positive discipline into practice (indicator 7) across domains. In order to gain better insight into progressive knowledge on positive discipline, the sixth indicator assessed under Child Protection is % increase in knowledge on positive discipline. Attitudes on positive discipline Following from CP indicator 6, the seventh indicator assesses progress in the % increase in positive attitudes/perceptions on positive discipline.

7.2. Qualitative findings overview 7.2.1. Supply and demand of services The focus of the child protection and GBV indicators for this study are related to child marriage, awareness of child protection risks, access to child protection and GBV services, child labour and participation of children in armed violence. The qualitative data highlights that both supply and demand of services on child protection and GBV are limited. Overall, there are many protection needs that do not however translate into demands for services. MOSA/SDCs Important suppliers of social and protection services are the country’s, at the time of writing, 228 SDCs that sort under MOSA. A number of SDCs also provide health services, such as dental care, paediatrics 118

UNICEF 2016a: 268-269. Ibid: 272. 120 Ibid: 273. 119

151 and gynaecology, that seem to be popular with Syrian respondents in FGDs and increasingly with Lebanese respondents as well. SDCs report to MOSA regional offices, collaborate with different NGOs and with MOPH. An objective of SDCs is to provide complementary services in one place, where patients and individuals coming to seek one service will be made aware of other services. SDCs visited as part of this research in the mohafazat of Akkar and Bekaa were working on integrating beneficiaries into different protection programmes, which include awareness raising, psychosocial support activities, safe spaces for women and case management. These services are provided by UNICEF implementing partners in and around SDCs. Some SDCs also handle cases of child protection, such as referrals of children to residential institutions. At the time of writing, SDCs’ work on this is limited, however MOSA is aiming to focus more on referrals in the next few years. Data from the FGDs highlight that few respondents are aware about MOSA/SDCs’ protection services for children and women. In FGDs, Lebanese were less aware about MOSA/SDCs than Syrians; Syrian women mentioned seeking MOSA/SDCs for medical services related to dental care and vaccinations for children. The qualitative data indicates that MOSA/SDCs are harder to access in remote areas, that directors play a vital role in the positive development of the MOSA/SDC and that the delivery of social services are often limited in scope and resources. Another significant challenge for everyone seeking protection services is the lack of a structured approach. As long as the full range of services is not existent or provided, let alone easily available as information, beneficiaries will be hesitant to seek protection services. Among other barriers, such as lack of knowledge of available service or physical distances, social norms relating to the family’s ‘reputation’ mean that the scope of MOSA/SDCs and other service providers can be limited when it comes to GBV. Beneficiaries do not always prefer to follow up or get support from formal actors, as it could have a negative impact on social reputation and potentially increase protection risks for them. Cases of child protection are more socially accepted than GBV, and programmes such as community-based psycho-social support (PSS) work to reduce the stigma. Crucially, the level of demand for protection services does not always match the needs: lack of awareness of the available services for children and women as well as social norms might deter individuals to make use of available services for themselves or their children. NGOs NGOs represent a significant supplier of CP and GBV services. Programmes focus on awareness raising, PSS activities, safe spaces for women and children as well as case management. NGOs working in Lebanon are both international and national; interviews with relevant key informants indicate the increasing capacities and expertise of local organisations specialising on CP and GBV. While most NGO services are available around the centre, Beirut and Mount Lebanon, increasingly local organisations are expanding their services to more peripheral areas and are working on delivering the same level of quality programmes. Approaches to working on CP and GBV differ between the different mohafazat, including on social norms and the nature of social organisation. For instance, raising awareness and working on CP issues in Akkar in an effective way requires a certain community-based approach, working closely with community and religious leaders, as well as with socially active women. The approach taken in Akkar might differ to that in the South or Mount Lebanon. Moreover, programmes are designed in ways as to not stigmatise the specific target groups. For example, an interviewed protection NGO-worker highlighted that girls aged 15-17 years represented the most isolated group, as they often have dropped out of school, stay indoors and are at risk of child marriage. In order not to stigmatise them, activities targeting them focusing on empowerment, parental skills and family planning include other girls and women from the community who are up to

152 22 years old. In Palestine refugee camps, NGOs work to provide community-based CP and GBV services inside the designated camps. Overall, NGOs estimate that while CP and GBV needs will increase over the few years, funding for services will decrease. Both state and non-state protection service providers work on demandcreation, although there is still a long way to go both in terms of strengthening existing structures and changing attitudes towards acceptability of accessing these services.


Mount Lebanon

Akkar

North

Bekaa

BaalbekHermel

South

Nabatieh


Syrian girls

Syrian boys

Lebanese boys

Syrian mothers (IS)

Lebanese girls

Syrian fathers

Lebanese mothers

Table 7.2: CP FGDs matrix CP issues have been raised in FGDs across all domains and mohafazat. This section will focus specifically on issues pertaining to the CP sector, including CP and GBV risks. FGDs provided a qualitative baseline on when both parents and children themselves considered boys and girls to become ‘adults’. The findings highlight some variation along domains and mohafazat. In the FGDs on CP, Palestine refugee mothers in Beirut stated the youngest age (15 years) of children becoming adults, while Lebanese mothers in Nabatieh stated the oldest age (28 years). Most caregivers considered children to become adults between the ages of 15 to 18 years. An analysis of the qualitative data highlights a slight discrepancy between caregivers’ and children’s own opinion on this specific question, as most children believe to become an adult between the ages of 16 and 22 years. The suitable age for marriage also differed slightly among domains and mohafazat, although adults’ and children’s responses corresponded more closely to each other: the marriage window for girls was between the ages of 16 to 22 years, while it was between 20 and 25 years for boys. Syrians respondents note that the age of marriage has become lower from when they were back in Syria as young people are marrying younger. Interestingly, caregivers of the four domains warn against marrying young. While some speak from experience and regret marrying young, others married at a later age and expressed their worry at this trend. “My daughter had read about the ‘facts of life’ on Google before getting married. I was surprised but my daughter said she was too shy to ask me.” Palestine refugee mother, FGD in Beirut, May 2017 Reasons for the changing pattern and trend in the marriage age are argued to be related to structural issues and out of the direct control of caregivers. Lebanese respondents highlight two parallel trends regarding the decision on when to get married: while the age of marriage is increasing for some because of longer time to complete studies and start a career, exposure to the outside world and increase of social media use, where boys and girls can talk virtually instead of having to meet physically, are also argued to lower it. Marriage is expressed as a form of ‘protection’ for both boys and girls who

153 are facing daily protection risks, such as physical or sexual harassment. Marriage is also seen as a way to alleviate financial pressures on families and as a desire by young people themselves to gain independence. While Syrians cite structural realities of displacement as the reasons for child marriage, with only very little they can do about it, Lebanese caregivers express a stronger responsibility for parents in case of child marriage, believing that parents should not allow young people under 18 years to get married. “I believe that the parents are to blame if they force their daughter into early marriage, although there are cases where the girl decides to marry young.” Lebanese mothers, FGD in Nabatieh, June 2017 Across population groups, qualifying for marriage is strongly based on girls and boys having certain ‘skills’. Both boys and girls need to have a certain level of ‘maturity’, where they are perceived being able to take on responsibility. While girls need to be able to cook and take care of their own household, boys need to be able to support a family, have an income and work. These gendered prerequisites are confirmed by caregivers and children respondents. The FGDs with boys highlight the strong awareness of their role as protectors and providers of their (future) families. Some boys openly expressed their worries of the pressure and feasibility to achieve this ideal, therefore resorting to child labour and dropping out of school if necessary. Lebanese boys placed a bigger emphasis on education than Syrian boys, with the aim to obtain qualifications or professional skills for later in life. “An adult man has the biggest responsibilities for his home and family. He works to ensure his kids’ future and support all the family.” Lebanese boy, FGD in North, May 2017. Harmful consequences related to child marriage were cited by several respondents. Health risks were only expressed by Lebanese boys and Palestine refugee mothers, and related mostly to the mother’s health. Syrian and Lebanese respondents stressed the social repercussions of child marriage, although this could be due to the framing of the FGDs, which focused on social aspects of people’s lives. Social repercussions of child marriage include girls not pursuing their education due to their husband disliking it or due to pregnancy and childcare duties. Education is perceived by all population groups as a safety net for girls, yet in practice few girls accomplish the level of education that parents and they themselves aspire to achieve. Moreover, marrying at a younger age is perceived to increase the risk of divorce and separation. Syrian mothers at an IS in the Bekaa mentioned the worrying trend of early marriage and early divorce among their community. Moreover, respondents also mention social risks of marrying ‘too late’, leaving a relatively small age window between girls being perceived as too young and too old to wed. Overall, caregivers of all domains are knowledgeable on protection risks. The most significant risks perceived by all are physical and sexual harassment and violence outside the home. Steps taken to mitigate these risks include limiting girls’ mobility outside the home, by either insisting on a male relative to accompany girls or not allowing them to walk outside in the dark. Increasingly, protection risks for boys are recognised as well but unlike for girls, there are very few practical steps that can be taken to ‘protect’ them, at least as perceived by respondents. Respondents mentioned that boys face physical dangers when working in hazardous activities, financial exploitation by employers and exposure to sexual harassment or content. For instance, a Syrian caregiver stated that while at the football pitch, a young man has displayed a pornographic video on his smartphone to younger Syrian boys. “I cannot report for a woman I do not know. It is her family’s responsibility and affair more than mine.” Syrian woman, IS, FGD in Bekaa, May 2017

154 There is a consensus among caregivers that they would tell someone in case they saw or heard of a child in a situation of danger, whether it directly concerned them or not. However, very few respondents stated that they would resort to seeking formal services. The majority would tell people they know and the parents of the child. Lebanese respondents are more willing to resort to state and non-state actors, including security forces or NGOs, although they perceive state services as not being effective and not able to support in cases of ‘personal’ issues. Syrian respondents on the other hand do not know who to speak to for support. Generally, respondents stated being reluctant to tell someone external to their close circle, let alone report to authorities, when it comes to GBV cases.

7.3. Baseline indicators: Child protection 7.3.1. All domains Knowledge on protection risks For boys, the three most perceived protection risks across the four domains are physical and sexual harassment at 32%, basic needs not being met at 30% and exploitation at 28%. For girls, the three most perceived protection risks are physical and sexual harassment at 42%, verbal harassment at 34% and basic needs not being met at 31%. Basic needs not being met include not having adequate access to food, shelter or clothing. Aside from indicating the level of knowledge on existing protection risks, this indicator also reveals respondents’ attitudes about what constitute the protection risks faced by boys and girls in Lebanon. Usually, basic needs not being met does not constitute a protection risk by itself, but rather exacerbates other CP risks. The high levels of responses on children’s basic needs not being met in the framework of this study however indicates that survey respondents consider it a protection risk. For this indicator, respondents were able to state multiple responses. When violence was mentioned, respondents probed about violence in the home or community, which is why the total percentages in the domains do not add up to 100%. Rather, the percentages refer to the ratio of answers for each option. Knowledge of harmful consequences of child marriage 73% of respondents believe that marriage under 18 years of age has negative consequences and could name at least one negative consequences. While 8% of respondents were undecided, in the sense of not having a clear opinion about this question, 17% believed that child marriage did not have negative consequences at all. Of those respondents who believed that child marriage had negative consequences or who were undecided, 45% believed that child marriage risked the mother’s opportunities for work or education and 18% believed that it increased the risk of domestic violence, while 38% believed that it presented a threat on the psychological wellbeing of the mother and on the mother’s life during pregnancy. Another 5% simply stated that their perception that the girl was too young. For this indicator, respondents were able to state multiple responses, which is why the total percentages in the domains do not add up to 100%. Rather, the percentages refer to the ratio of answers for each option.

155

% of respondents who believe that marriage under 18 years of age has negative consequences and could name at least one negative consequence

Lebanese residents




Male

75%

63%

48%

50%

Female

77%

66%

62%

71%

Total

76%

64%

60%

62%

Total

73%

Table 7.3: Overview of CP indicator on knowledge of harmful consequences of child marriage by domain, gender and in total

Mother not accessing opportunities such as work or education

45%

Threat on psychological wellbeing of mother,

38%

Threat on mother’s life during pregnancy

38%

Threat on mother’s life at birth

30%

Life-long health consequences for the mother

29%

Threat on baby’s life (prematurity, low birth weight, developmental delays/disorders) Increased risk of and exposure to domestic violence,

24% 18%

Threat on foetus life

16%

Young DK

5% 1%

Table 7.4: Negative consequences of child marriage as cited by total respondents Knowledge on how to report CP and GBV violations Rather than asking directly whether respondents knew how to formally report cases of GBV and CP, which might have led to biased responses, they were asked whether they ‘would inform someone’ in case of GBV and CP risks. The question relating to GBV was formulated in an indirect way, asking respondents what they think a woman would do if she was a victim of violence, and who she would tell about the incident in case she had to inform someone. For children, respondents were asked more directly what they would do if they saw or heard that a child (under 18 years) was in a situation of danger, and if they had to inform someone about it, who they would turn to. All respondents were

156 probed on who they would tell in case the perpetrator of violence was the husband or close family members. Crucially, instead of asking respondents who they would ‘report to’, the emphasis was on who they would inform about a protection issue. This provided more accurate information on who respondents felt more comfortable to reach out to. The findings show that there is a high level of readiness to tell someone about an incidence of violence inflicted on a woman or child, but that most accounts would stay among informal actors, including close family members, especially the husband, friends and neighbours. This indicates that many cases of GBV and CP would go unreported to formal authorities and highlights a need for more community-based awareness on available GBV and CP services. Respondents who state that they would tell MOSA, NGOs or local authorities are considered to formally report cases of GBV and CP. The percentage of respondents who state to reach out to these formal channels are therefore counted for this indicator. If a woman in the community was a victim of violence, 93% of respondents stated that she would inform someone about it. However, only 17% of respondents stated that a woman would report a case of GBV to formal authorities. Of those, 16% would report to MOSA or NGOs and 1% to local authorities. In contrast, 40% stated that she would report to her husband, 20% to a community leader and 12% to parents or a caregiver. If respondents saw or heard that a child they knew was in a situation of danger, 95% stated that they would inform someone or report the case. 21% of total respondents stated that if they had to report a protection issue for a child, they would report it the formal authorities. Of those, 17% would report to MOSA or NGOs and 5% to local authorities. Comparatively, 38% would report to the child’s parents or caregivers, 24% to nobody and 11% to neighbours and friends.

% of respondents who believe that a woman would report to formal authorities if she had to tell someone about a GBV incident % of respondents who would report to formal authorities in case they had to tell someone about a case of CP

Lebanese residents




Male

24%

18%

9%

13%

Female

31%

19%

16%

24%

Total

28%

19%

14%

20%

Male

34%

20%

16%

17%

Female

37%

24%

14%

32%

Total

36%

22%

14%

25%

Total

17%

21%

Table 7.5: Overview of CP indicator on knowledge of reporting CP and GBV violations by domain, gender and in total Positive attitude towards seeking CP, GBV and other services through MOSA and NGOs

157 49% of respondents believed that protection services provided to children and women through MOSA and NGOs are helpful. In contrast, 36% did not believe that they were, 13% were undecided and 2% believed that the services were not needed.

% of respondents who believe that protection services provided to children and women through MOSA and NGOs are helpful

Lebanese residents




50%

40%

32%

51%

51%

38%

52%

62%

50%

40%

42%

56%

Total

Male

Female Total

49%

Table 7.6: Overview of CP indicator on positive attitudes towards seeking CP and GBV services through MOSA and NGOs by domain, gender and in total Attitudes of community members on participation of minors in armed violence When asked in which circumstances the participation of children under 18 years in armed violence was justified, 93% of community members answered that it was not justified under any circumstances. Comparatively, 6% argued that it was justified when the community was under threat or attack, 4% to earn money, for religious causes and for political causes respectively.

% of respondents who answer that children’s participation in armed violence is not justified under any circumstances

Lebanese residents




Male

93%

94%

95%

83%

Female

93%

90%

95%

91%

Total

93%

93%

95%

87%

Total

93%

Table 7.7: Overview of CP indicator on attitudes towards participation of minors in armed violence by domain, gender and in total Caregivers’ knowledge of the minimum working age, working hours and types of work which are legally allowed in Lebanon for children 83% of the total respondents stated that the minimum working age in Lebanon by law is from 18 years of age and older. 6% of respondents were undecided, 11% believed the minimum working age to be between 14 and 16 years, with 4% stating exact 16 years of age. Only 5% of total respondents stated that the maximum number of working hours per day for children by law is 6 hours. The overwhelming majority, at 91%, stated that the maximum number of working hours per day for children was between 7 and 10 hours by law.

Lebanese residents




Total

158 % of respondents who know that the minimum working age in Lebanon is from 18 years and older % of total respondents who know that the maximum number of working hours per day for children by law is 6 hours

Male

85%

79%

80%

81%

Female

87%

69%

57%

72%

Total

86%

75%

61%

76%

Male

4%

3%

2%

4%

Female

5%

4%

13%

5%

Total

5%

4%

11%

5%

83%

5%

Table 7.8: Overview of CP indicator on knowledge on child labour by domain, gender and in total The graph below shows a breakdown of the types of work respondents believe children above the perceived minimum working are legally allowed to work in. Street work has the highest proportion of affirmative responses at 97% and domestic work has the lowest affirmative responses at 53%.

Street work/begging

97%

Construction

57%

Mechanics/garages

43%

55%

Shops

3%

45%

67%

Domestic work

Yes

33%

53%

Agriculture

No

47%

59%

41%

Table 7.9: Types of work total respondents believe children above the minimum working age are legally allowed to work in Knowledge on positive discipline 71% of respondents stated that it is wrong to hit children, indicating knowledge on alternative nonviolent methods of discipline. 22% stated that hitting children can be justified depending on the circumstance while 7% believed that hitting children was not wrong.

% of respondents who know that it is wrong to hit children

Lebanese residents




72%

75%

73%

70%

69%

73%

62%

66%

Male

Female

Total

159 Total

70%

74%

63%

68%

71%

Table 7.10: Overview of CP indicator on knowledge on positive discipline by domain, gender and in total

Attitudes on positive discipline 84% of respondents exhibit favourable attitudes on positive discipline methods as they believe them to be useful. Comparatively, 27% of respondents find verbal violence and 15% find physical violence disciplining methods useful.

% of respondents who exhibit positive attitudes towards positive discipline methods

Lebanese residents




84%

86%

74%

73%

86%

87%

83%

73%

85%

86%

82%

73%

Total

Male

Female Total

84%

Table 7.11: Overview of CP indicator on attitudes towards positive discipline by domain, gender and in total Disciplining methods121

Useful

Not useful

Explain to child why his/her behaviour was wrong

95%

5%

Give the child something else to do

83%

17%

Take away privileges or forbidding something the child likes to do

75%

25%

Call the child dumb, lazy or another word like that

19%

81%

Shout at child

35%

65%

Spank, hit or slap the child on the bottom

23%

77%

Spank, hit or slap the child on the face or the rest of the body

7%

93%

Table 7.12: Responses on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue) in total122

7.3.2. Lebanese residents’ domain

121

These positive disciplining methods are adapted from UNICEF. 2010. Child disciplinary practices at home: Evidence from a range of low- and middle-income countries, page 14. Available at: https://www.google.com.lb/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiY 7bjAhMXWAhUCvBoKHdtbBVwQFggpMAA&url=https%3A%2F%2Fwww.unicef.org%2Fprotection%2FChild_Disc iplinary_Practices_at_Home.pdf&usg=AFQjCNF1HRtYJKU4zHpRnhLv5iTzXnx_5g 122

The domain breakdown is available in below sections

160 Knowledge on protection risks When asked when boys are at risk of danger in their environment, the three most perceived protection risks by Lebanese respondents were physical and sexual harassment at 34%, exploitation at 29% and basic needs not being met at 28%. Other interesting results are 22% citing no access to school or healthcare and 18% citing abandonment by parents or caregivers. Female respondents have a slightly higher response rate than male respondents, but no striking gender differences can be noted.

3% 2%

5% 10% 11%

18%

14% 15% 12% 16% 11% 17% 18%

29%

22% 22% 22%

Moral Corruption Don’t know Substance abuse Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

34%

25% 28%

Drugs Abandonment by parent or caregivers Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

Table 7.13: Attitudes towards protection risks for boys by Lebanese respondents When asked when girls are at risk of danger in their environment, the three most mentioned protection risks are physical and sexual harassment at 44%, verbal harassment at 34% and exploitation at 30%. Results are more or less similar for boys and girls. However, levels of sexual violence in the home are perceived as slightly higher for girls, and 12% of Lebanese respondents perceive prostitution as a protection risk for girls. Female respondents perceive that violence in the home and community is slightly more a protection risk than male respondents do. Data from the qualitative research seconds the qualitative findings, as Lebanese female caregivers in FGDs highlight the occurrence of sexual violence in homes affecting women and girls the most, as well as high levels of violence between family members.

161

2% 2% 1%

12% 11% 11% 12% 12% 11% 9% 13%

18% 30%

16% 17%

23% 22% 22% 23%

Moral Corruption Don’t know Abandonment by parent or caregivers Child marriage Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

34%

44%

27% Drugs Prostitution Substance abuse Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

Table 7.14: Attitudes towards protection risks for girls by Lebanese respondents Knowledge of harmful consequences of child marriage When asked at what age girls usually get married in their communities, 72% of Lebanese respondents stated by 20 years and over; 21% stated by 18 years and 5% by 16 years of age. On a mohafaza level, Bekaa and Baalbek-Hermel had the highest reported rates of girls marrying by the age of 16 years at 16% and of 18 years at 45% compared to other mohafaza. The perceived age of girls’ marriage is the lowest in Baalbek-Hermel, while the highest is in Mount Lebanon.

162

South

1% 6%

North

1%4%

Mount Lebanon El Nabatieh Bekaa

Akkar

70%

25%

89%

2% 8% 1% 76%

6% 13% 1%4%

36%

16%

1%

2% 5%7%

By 20 years and over

46% 63%

30%

8%


65%

29%

36% 44%

17%

63%

24% By 18 years

By 16 years

By 14 years

By 12 years

Table 7.15: Perceived age at which girls usually get married cited by Lebanese respondents by mohafaza 76% of Lebanese respondents believe that marriage under the age of 18 years has negative consequences and named at least one of them. While 8% of Lebanese respondents were unsure whether marriage under the age of 18 years has any negative consequences, 14% stated that there were no negative consequences. Responses were more or less consistent across mohafaza. Beirut had the lowest affirmative response rate at 65% and the highest response rate for ‘maybe’ at 17%. Akkar and the North had the highest response rates for those who believed that marriage under the age of 18 years does not have any negative impacts, at 28% and 22% respectively. Of those 84% of Lebanese respondents who believed that stated that marriage under the age of 18 years has, or might have, negative consequences, almost 50% cited the negative consequence of mothers not accessing education or work opportunities as result. Around 40% cited the threat on the psychological wellbeing of the mother, while 36% cited the threat of the mother’s life during childbirth. 20% of respondents mentioned the increased risk of exposure of domestic violence, indicating some level of knowledge gap on GBV risks.

163 Early divorce

1%

Young

5%

DK

1% 19% 48% 39% 21% 15% 27% 28% 36%

Increased risk of and exposure to domestic violence, Mother not accessing opportunities such as work or education Threat on psychological wellbeing of mother, Threat on baby’s life (prematurity, low birth weight, developmental delays/disorders) Threat on foetus life Life-long health consequences for the mother Threat on mother’s life at birth Threat on mother’s life during pregnancy

Table 7.16: Reasons cited by Lebanese respondents who believe that child marriage has or might have negative consequences Knowledge on how to report CP and GBV violations If a woman in the community was a victim of violence, 94% of respondents stated that she would inform someone about it. However, only 28% of respondents stated that a woman would report a case of GBV to formal authorities, namely to MOSA, NGO or local authorities. Of the total female respondents, 31% stated that she would report to formal authorities compared to 24% of total male respondents. This question was multiple choice, and most chose the options to report to the husband and community leader.

164

Female

1% 3% 3% 1%

30% 22%

8% 1% Male

17%

6%

57% 44%

3% 1% 8%

18% 13%

53%

I do not know how to report

Report to nobody

Report to community leader

Report to religious leader

Report to local authorities

Report to MOSA or NGO

Report to neighbors or friends

Report to her parents or caregivers

Report to her husband

Table 7.17: Lebanese respondents’ attitudes on whom a woman would inform regarding a protection issue for herself by gender The highest proportion of respondents stating that women would report to community leaders are in Baalbek-Hermel and Bekaa at 32% and 29% respectively. Akkar, Beirut and North have the highest rates of reporting to the husband, at 82%, 75% and 72% respectively. While Mount Lebanon has the highest proportion of respondents replying reporting to MOSA or NGOs at 32%, in Bekaa 30% would report to MOSA. If respondents saw or heard that a child they knew was in a situation of danger, 95% Lebanese respondents stated that they would inform someone or report the case. 36% of Lebanese respondents stated that if they had to report a protection issue for a child, they would report it the formal authorities, namely to MOSA, NGOs or local authorities. 34% of total male respondents state they would report to formal authorities, compared to 37% of female respondents. Respondents were asked as multiple choice, and most chose the options to report to the parents and caregivers and to report nobody. Strikingly, almost 50% of Lebanese male respondents also stated not to report to anyone for a child protection issue. Since respondents were probed on who else they would tell about the CP issue if the caregivers or relatives were the perpetrators, the relatively high levels of ‘report to nobody’ could indicate a lack of knowledge on who else aside from caregivers’ respondents would seek support from for the child in question.

165

4% Female

3% 1%

34% 8%

20%

9%

16%

53%

4% Male

3% 1%

47%

5% 12% 12%

18%

49%


Report to nobody




Ministry of Social Affairs / Specialized Care

Report to an NGO



Table 7.18: Formal and informal actors Lebanese respondents would inform about a protection issue for a child under 18 years by gender Almost 30% of respondents in the Mount Lebanon and 21% of respondents in the Bekaa stated to report to MOSA in case of a child protection issue. Mount Lebanon and Bekaa have the highest response rates to reporting to NGOs, at 15%. Interestingly, Mount Lebanon also had the highest response rate on not reporting to anyone at 52%, followed by Baalbek-Hermel at 40%. Positive attitude towards seeking CP, GBV and other services through MOSA and NGOs 50% of Lebanese respondents believed that protection services provided to children and women through MOSA and NGOs are helpful. In contrast, 36% did not believe that they were, 11% were undecided and 2% believed that the services were not needed. While half of total Lebanese respondents had a positive attitude towards seeking protection services through MOSA and NGOs, fewer respondents had previously mentioned that a woman would report to MOSA or NGOs in case of a protection issue in the above indicator, potentially highlighting an overly positive response.

166

Female

Male

11%

2%

35%

51%

11%

2%

37%

DK

Services are not needed

50%

No

Yes

Table 7.19: Lebanese respondents who believe protection services provided to children and women through MOSA and NGOs are useful by gender Nabatieh and Bekaa had the highest levels of affirmative responses towards seeking CP and GBV services through MOSA and NGOs at 67% and 64% respectively. North, Akkar and South have the least affirmative responses ranging between 52 and 45%. In FGDs, Lebanese female respondents were not aware that some MOSA provided GBV services and were also not aware of the relevant NGOs in their surroundings, but mentioned that they would like to make use of services if the latter were available.

6% 9%

South

North

40% 1%

9%

Bekaa

Beirut

Baalbek-El Hermel

52%

38% 15%

Mount Lebanon

El Nabatieh

45%

31% 2% 1% 1%

54%

30%

67%

22% 14%

64%

2% 5%

40%

52%

16%

1%

25%

59%

10%

Akkar

41% DK


No

49% Yes

Table 7.20: Lebanese respondents who believe protection services provided to children and women through MOSA and NGOs are useful by mohafaza

167 Attitudes of community members on participation of minors in armed violence When asked in which circumstances the participation of children under 18 years in armed violence was justified, 93% of Lebanese community members answered that it was not justified under any circumstances. Comparatively, 6% argued that it was justified when the community was under threat or attack, 3.5% to earn money, 4% for religious causes and for 3% for political causes. Caregivers’ knowledge of the minimum working age, working hours and types of work which are legally allowed in Lebanon for children 87% of Lebanese respondents believed the minimum working age by law to be 18 years. 4% believed it to be 16 years and 3% were unsure. 92% of Lebanese respondents stated the maximum number of working hours to be 7-10 hours per day, while 5% stated it to be 6 hours. The type of work that most Lebanese respondents believed children to be allowed to work in is related to shops. In contrast, 98% of respondents stated that street work or begging was not a type of work allowed for children. Beirut


Nabatieh

Mount Lebanon

North and Akkar

South

Total

Street work/begging

5%

1%

2%

2%

3%

3%

2%

Construction

33%

38%

39%

31%

75%

34%

42%

Mechanics/ garages

43%

54%

46%

40%

81%

50%

52%

Shops

77%

67%

56%

55%

84%

56%

65%

Domestic work

46%

50%

23%

50%

61%

52%

51%

Agriculture

40%

60%

51%

51%

81%

48%

57%

Table 7.21: Types of work Lebanese respondents believe children above the minimum working age are legally allowed to work in by mohafaza Knowledge on positive discipline 70% of respondents believed that it is wrong to hit children, indicating knowledge on alternative non-violent methods of discipline. Around 22% stated that hitting children can be justified depending on the circumstance while 7% believed that hitting children was not wrong. The qualitative data shows that Lebanese caregivers prefer using non-physical disciplining methods for their children. For example, female caregivers in Mount Lebanon mentioned that dialogue was the basis of the relationship between parents and children. Among domains, Lebanese were the most aware of, and vocal about, developing decision-making abilities and the character of children. Attitudes on positive discipline 85% of respondents exhibit favourable attitudes on positive discipline methods as they believe them to be useful. The positive discipline method that was perceived the most useful by Lebanese respondents was the explain to the child why his/her behaviour was wrong at 95%. Verbal violence as a method for discipline was perceived at useful by 26% of Lebanese respondents, while 14% believe that physical violence was useful as a method for discipline.

168 Disciplining methods

Useful

Not useful


95%

5%


83%

17%


77%

23%


18%

82%

Shout at child

35%

65%


21%

79%


7%

93%

Table 7.22: Lebanese respondents’ attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue)

7.3.3. Syrians registered with UNHCR domain Knowledge on protection risks Asked when boys are at risk of danger in their environment, the three most perceived protection risks were: basic needs not being met at 34%, no access to school and healthcare services at 31% and exploitation as well as physical and sexual harassment at 29%. Other interesting results are physical violence in the community at 26% or child labour at 22%. Although basic needs not being met that lack of access to services such as health care and education do not constitute protection risks per se, but rather lead to protection risks, in the framework of this study they indicate perceived protection risks by respondents. “In Syria, boys became men after the obligatory military service. In Lebanon, children are becoming adults before they should. They are not living their childhood.” Syrian male caregiver, FGD in the South, June 2017

169

1% 2% 2% 1%

13%

Kidnapping Drugs Abandonment by parent or caregivers Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

16% 18% 29% 19% 22% 18% 20% 15% 26% 19% 25% 20% 29% 27%

31%

34%

Moral Corruption Don’t know Substance abuse Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

Table 7.23: Attitudes towards protection risks for boys by Syrian respondents registered with UNHCR Asked about when girls are at risk of danger in their environment, registered Syrian respondents believe that girls are the most at risk from their basic needs not being met at 42% and from physical and sexual harassment at 39%. Verbal harassment, no access to school or healthcare services, exploitation and sexual violence in the community also scored relatively high with at least one third of respondents stating these risks.

170

1% 3% 1%

17% 16% 18% 18% 19% 22% 20% 20% 19% 25% 23% 26% 21%

34% 31%

34% 34% Kidnapping Don’t know Abandonment by parent or caregivers Child marriage Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

39%

Moral Corruption Prostitution Substance abuse Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

42%

Table 7.24: Attitudes towards protection risks for boys by Syrian respondents registered with UNHCR

Knowledge of harmful consequences of child marriage When asked at what age girls usually get married in their communities, 32.5% of registered Syrian respondents stated by 20 years and over, approximately half of the proportion of Lebanese respondents. 32% stated that girls get married by 18 years, 21.5% by the age of 16 years and 13.5% by the age of 14 years. On a mohafaza level, the highest response rates for girls marrying at 20 years and over are exhibited in the North and Akkar at 53% and in Nabatieh at 46%. The highest response rates for girls marrying by 18 years are in Beirut at 43% and Bekaa at 36%. Bekaa and Baalbek-Hermel, as well as South, have the highest response rates for girls marrying by the age of 16 years. In Baalbek-Hermel, almost 30% of respondents stated that girls in their communities married by the age of 14 years, while Beirut came in second place at 23%.

171


14%

1%

23% 23%

1%

16% 13%

Bekaa 10%

36% 35%

13%

24%

1%

28%

34% 41%

5%

By 20 years and over By 14 years

43%

23% 23%

Beirut

1%

46%

30%

16%

8%

38%

31%

15% 15%

Baalbek-El Hermel

53%

33%

5% 8%

El Nabatieh

Akkar

39%

By 18 years By 12 years

54%

By 16 years By 10 years

Table 7.25: Perceived age at which girls usually get married cited by Syrian respondents registered with UNHCR by mohafaza 64% of registered Syrian respondents believe that marriage under the age of 18 years has negative consequences and named at least one of them. While 8.5% of respondents were unsure whether marriage under the age of 18 years has any negative consequences, 25.5% stated that there were no negative consequences. The highest affirmative response rates for whether marriage under 18 years has any negative impact on the girl being married were exhibited in Akkar, Bekaa and Beirut – where rates of child marriage are relatively high, indicating that drivers of child marriage are less based on knowledge and more on difficult living conditions.

172 Young Increased risk of and exposure to domestic violence,

2% 10%


34%

Threat on psychological wellbeing of mother,

37% 39%

23% 36%

Threat on baby’s life (prematurity, low birth weight, developmental delays/disorders) Threat on foetus life Life-long health consequences for the mother

33%

Threat on mother’s life at birth

42% Threat on mother’s life during pregnancy

Table 7.26: Reasons cited by Syrian respondents registered with UNHCR who believe that child marriage has or might have negative consequences Of the 73% of registered Syrian respondents who believed that child marriage has or might have negative consequences, health risks for the mother and child were mentioned the most, including threats on the mother’s life, life-long health complications and psychological impact, but also threats on the baby’s life. Social consequences were also stated: 34% mentioned that the mother would not access education or work opportunities because of child marriage. Only 10% of respondents mentioned the increased risk of exposure of domestic violence, indicating a knowledge gap on GBV risks. “I want to get married at the age of 20 years. A married woman needs to be responsible enough to take care of herself, her home and new family. She needs to be strong.” Young Syrian girl, FGD in Mount Lebanon, May 2017

Knowledge on how to report CP and GBV violations If a woman in the community was a victim of violence, 93% of respondents stated that she would inform someone or report the case. However, only 18% of registered Syrian respondents stated that a woman would report a case of GBV to formal authorities, namely to MOSA, NGOs or local authorities. 18% of male registered Syrian respondents believe that a woman would report to formal authorities, while 19% of female registered Syrian respondents believe that a woman would seek formal reporting pathways. Overall, 63% of registered Syrian respondents believe that a woman would inform someone from the immediate family on a protection issue, namely to the husband or parents/caregivers, indicating a strong reliance on informal networks. On a mohafaza level, the highest affirmative response rate of women reporting to their husband was in the North and Akkar at around 90%.

173

5% Female

2% 1% 5%

24% 11% 31%

4% Male

2% 3% 3%

75%

30% 9% 23%

69%

Report to nobody




Report to an MOSA or NGO




Table 7.27: Syrians respondents registered with UNHCR’s attitudes on whom a woman would inform regarding a protection issue for herself by gender If respondents saw or heard that a child they knew was in a situation of danger, 96% of registered Syrian respondents stated that they would inform someone or report the case. 22% of registered Syrian respondents stated that if they had to report a protection issue for a child, they would report it formal authorities, namely to MOSA, NGOs or local authorities. Of those, 24% are female and 20% are male respondents. 63% of female respondents and 57% of male respondents would report to the child’s caregivers or to neighbours and friends. Moreover, there is a significantly high proportion of respondents who would not report to anyone, with the highest percentages in Mount Lebanon at 52%, North at 36% and Akkar at 32%. Respondents were probed on who else they would tell about the CP issue if the caregivers or relatives were the perpetrators, the relatively high levels of ‘report to nobody’ could indicate a lack of knowledge on who else aside from caregivers’ people would seek support from for the child in question.

174

5% Female

1% 2%

7% 6%

28% 11% 30%

5% Male

1% 2% 4%

72% 37%

7% 9% 21%

I do not know how to report Report to community leader Report to local authorities Report to an NGO Report to her parents or caregivers

66% Report to nobody Report to religious leader Ministry of Social Affairs / Specialized Care Report to neighbors or friends

Table 7.28: Formal and informal actors Syrians respondents registered with UNHCR would inform about a protection issue for a child under 18 years by gender On the mohafaza level, 30% of respondents in Mount Lebanon and 20% in the South and Nabatieh would report to MOSA in case of a child protection issue. Over 50% of respondents in Mount Lebanon would report to nobody, while over 30% of respondents in the Bekaa stated not knowing how to report a child protection issue. Very few respondents would report to an NGO, especially in more rural governorates such as Bekaa, Baalbek-Hermel, Akkar and North. Positive attitude towards seeking CP, GBV and other services through MOSA and NGOs 40% of registered Syrian respondents believe that protection services provided to children and women through MOSA and NGOs are helpful. In contrast, the same proportion of respondents did not believe that they were useful, while 19% were undecided and did not know. The highest affirmative response rates towards seeking services through MOSA and NGOs were in Beirut at 67% and the North at 51%. The most negative responses were given in Akkar at 57%, North and Nabatieh at 48%. In the South, around 25% of registered Syrian respondents believed that CP and GBV services were not needed, while 50% in Baalbek-Hermel did not know whether they were useful.

175

Female

Male

19%

2%

41% 39% 18%

3%

39% 41%

DK


No

Yes

Table 7.29: Syrian respondents registered with UNHCR who believe protection services provided to children and women through MOSA and NGOs are useful by gender

23%

South

North

Mount Lebanon

El Nabatieh

Bekaa

Beirut

Baalbek-El Hermel

Akkar

40% 37%

1% 1%

48% 51% 22%

%

39% 39%

2%

18% 48%

32% 25%

%

35%

40%

3% 30% 1%

67% 49%

27% 23%

1% 42% DK


No

57%

Yes

Table 7.30: Syrian respondents registered with UNHCR who believe protection services provided to children and women through MOSA and NGOs are useful by mohafaza Attitudes of community members on participation of minors in armed violence When asked in which circumstances the participation of children under 18 years in armed violence was justified, 93% of registered Syrian community members answered that it was not justified under any circumstances. Comparatively, 7% argued that it was justified when the community was under threat or attack, 6.5% to earn money, for religious causes and for political causes.

176 Caregivers’ knowledge of the minimum working age, working hours and types of work which are legally allowed in Lebanon for children 75% of registered Syrian respondents believed the minimum working age by law to be 18 years or more. 13% were unsure about the legal minimum working age while 11%believed it to be at 17 years and younger. 93% of registered Syrian respondents believed the maximum number of working hours to be 7-10 hours per day, 4% believed 6 hours or less while 3% believed over 10 hours. The type of work that registered Syrian respondents believed children to be allowed to work in the most is in shops at 81%, while the second-most is in agriculture at70%. In contrast, 96% of respondents stated that street work or begging was not a type of work allowed for children.

Beirut


Mount Lebanon

North and Akkar

South and Nabatieh

Total

Street work/begging

0%

1%

8%

4%

5%

4%

Construction

37%

39%

32%

93%

28%

49%

Mechanics/ garages

40%

71%

45%

88%

51%

66%

Shops

87%

87%

68%

98%

57%

81%

Domestic work

37%

67%

54%

72%

58%

63%

Agriculture

47%

78%

45%

98%

49%

70%

Table 7.31: Types of work Syrian respondents registered with UNHCR believe children above the minimum working age are legally allowed to work in by mohafaza Knowledge on positive discipline 74% of respondents stated that it is wrong to hit children, indicating knowledge on alternative nonviolent methods of discipline. Around 21.5% stated that hitting children can be justified depending on the circumstance while 7% believed that hitting children was not wrong. Attitudes on positive discipline 86% of respondents exhibit favourable attitudes on positive discipline methods as they believe them to be useful. The positive discipline method that was perceived the most useful by registered Syrian respondents was the explain to the child why his/her behaviour was wrong at 97%. Verbal violence as a method for discipline was perceived at useful by 29.5% of respondents, while 13.5% believe that physical violence was useful as a method for discipline.

177 Disciplining methods

Useful

Not useful


97%

3%


85%

15%


76%

24%


26%

74%

Shout at child

33%

67%


22%

78%


5%

95%

Table 7.32: Syrian respondents registered with UNHCR’s attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue)

7.3.4. Syrians in ISs domain Knowledge on protection risks Overall, responses for this domain were relatively few compared to the others. Asked when boys are put in situations of danger, Syrian respondents in ISs gave an average of 2.3 answers, while for girls they gave an average of 3 answers. For boys, the three most perceived protection risks are basic needs not being met at 23%, exploitation at 22% physical violence in the community at 21%. Only 10% of respondents stated access to school and healthcare services, indicating that either needs are met or that they are not considered as a protection issue. The response rate for abandonment by parents or caregivers was also relatively high at 17%. This latter could relate to lack of care from caregivers towards their children or linked to caregivers’ support to their children marrying at younger ages.

1% 2%

14% 5%

17%

9% 13% 12% 11%

6%

21%

10% 6% 10% 10% Kidnapping Don’t know Substance abuse Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

22%

15%

17% 13% 23% Moral Corruption Abandonment by parent or caregivers Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

178 Table 7.33: Attitudes towards protection risks for boys by Syrian respondents in ISs Responses for girls were slightly different: 27% perceived that basic needs of girls were not met, 22% cited exploitation and physical and sexual harassment as protection risks faced by girls. 20% of respondents claim that girls face the risk of abandonment by parents or caregivers, perhaps related to the high levels of child marriage. Access to school and healthcare services were only mentioned by 13%. Although basic needs not being met that lack of access to services such as health care and education do not constitute protection risks per se, but rather lead to protection risks, in the framework of this study they indicate perceived protection risks by respondents.

1%

3% 14% 9% 20% 10% 12% 10% 22% 13% 15% 11% 14% 10% 19% 14% 18% 11% 22% 16% 13%

Kidnapping Don’t know Abandonment by parent or caregivers Child marriage Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

27%

Moral Corruption Prostitution Substance abuse Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

Table 7.34: Attitudes towards protection risks for girls by Syrian respondents in ISs Knowledge of harmful consequences of child marriage When asked at what age girls usually get married in their communities, only 10% of Syrian in ISs respondents stated by 20 years and over. 26% state that girls get married by 18 years, 33% by 16 years and 23% by 14 years. However, more female respondents than male state lower the ages: for instance, while 36% of the female respondents state that girls get married by 14 years of age, 20% of male respondents’ state so. Moreover, 3% of female respondents’ state that girls get married by the age of 12 years.

179

9%

19%

Female

33%

3% 11%

34% 34%

Male

20% By 20 years and over

By 18 years

By 16 years

36%

By 14 years

By 12 years

Table 7.35: Perceived age at which girls usually get married cited by Syrian respondents in ISs

60% of Syrian respondents in ISs believe that marriage under the age of 18 years has negative consequences. Of those, 98% were able at least one negative consequence. While 6% of respondents were unsure whether marriage under the age of 18 years has any negative consequences, 31% stated that there were no negative consequences. 41% of respondents believe that child marriage has a negative impact on the psychological wellbeing of the girl. This finding is validated by FGDs in which Syrian women highlight the prevalence of child marriage but also of high levels of depression among residents in the ISs. Syrians in ISs display more awareness on the increase in risk to domestic violence than the registered Syrians domain. In FGDs, Syrian women in ISs stressed that child marriage has increased in displacement. They highlighted the social risks associated with child marriage, such as the high levels of interpersonal violence and of divorce. Lack of safety was cited as a reason for marrying younger, as a way of ‘protecting’ young girls but also boys. Moreover, some elements of child marriage were also acknowledged to represent protection risks for girls, including being confined to work for the in-law’s family, conducting a lot of household chores and being relatively isolated and lonely. “I got married at 15 years. All my sisters got married at 14 years. My father decided it but I did not mind, it is better than waiting and risking doing something ‘haram’.” Syrian girl, FGD in an IS in Bekaa, May 2017

180

Young DK

6% 5%

Increased risk of and exposure to domestic violence,

19%


19% 41%

Threat on psychological wellbeing of mother, Threat on baby’s life (prematurity, low birth weight, developmental delays/disorders)

26% 11%

Threat on foetus life

34% 36% 30%

Life-long health consequences for the mother Threat on mother’s life at birth Threat on mother’s life during pregnancy

Table 7.36: Reasons cited by Syrian respondents in ISs who believe that child marriage has or might have negative consequences

Knowledge on how to report CP and GBV violations If a woman in the community was a victim of violence, 79% of respondents stated that she would inform someone or report the case, while 21% believe she would do nothing about it. Syrians in ISs have the lowest affirmative response rate on this issue. Moreover, only 14% of Syrian respondents in ISs believed that a woman would report a case of GBV to formal authorities, namely to MOSA, NGOs or local authorities. 9% of male respondents and 16% of female respondents believed that a woman would report a case of GBV to formal authorities. Overall, 76% of female and male respondents believe that a woman would resort to the immediate family to report a protection issue, namely to the husband or parents or caregivers.

181

Female

1% 1% 1% 5% 2%

2% Male

2% 2% 5% 2%

15% 9% 34%

73%

9%

27%

Report to nobody Report to religious leader Ministry of Social Affairs / Specialized Care Report to neighbors or friends Report to her husband

80% Report to community leader Report to local authorities Report to an NGO Report to her parents or caregivers

Table 7.37: Syrian respondents in ISs attitudes on whom a woman would inform regarding a protection issue for herself by gender If respondents saw or heard that a child they knew was in a situation of danger, 86% of Syrian respondents in ISs stated that they would inform someone or report the case, while 12% would not do anything. 14% of Syrian respondents in ISs stated that if they had to report a protection issue for a child, they would report it formal authorities, namely to MOSA, NGOs or local authorities. Among the total male and female respondents, 16% of male respondents and 14% of female respondents state that if they had to report a protection issue for a child, they would report it formal authorities. 73% of female respondents and 78% of male respondents would report to the child’s caregivers or to neighbours and friends. Moreover, there is a significantly high proportion of respondents who would not report to anyone, potentially indicating a gap in who to reach out to aside from the family or lack of access to justice.

182

3% 4% Female

4% 2%

19% 8% 32%

74%

11% Male

2% 2% 5%

9% 27%

Report to nobody Report to religious leader Ministry of Social Affairs / Specialized Care Report to neighbors or friends

75% Report to community leader Report to local authorities Report to an NGO Report to her parents or caregivers

Table 7.38: Formal and informal actors Syrians respondents in ISs would inform about a protection issue for a child under 18 years by gender Positive attitude towards seeking CP, GBV and other services through MOSA and NGOs 42% of Syrian respondents in ISs believe that protection services provided to children and women through MOSA and NGOs are helpful. In contrast, 21% of respondents did not believe that they were useful, while another 21% were undecided and did not know. Women had a higher affirmative response rates towards seeking services through MOSA and NGOs than men, at 52% compared to 32%. In FGDs, Syrian women often expressed not knowing where to receive support from, indicating a lack of knowledge on available services and where to find them in the first place. “Who would you report to here? You cannot report a case, because of issues of reputation. You can never report without the parents’ consent.” Syrian female caregiver, FGD in an IS in Bekaa, May 2017

22% Female

25% 52% 20%

Male

2% 45% 32% DK


No

Yes

Table 7.39: Syrian respondents in ISs who believe protection services provided to children and women through MOSA and NGOs are useful by gender

183

Attitudes of community members on participation of minors in armed violence When asked in which circumstances the participation of children under 18 years in armed violence was justified, 95% of Syrian community members in ISs answered that it was not justified under any circumstances. Comparatively, 4% argued that it was justified when the community was under threat or attack. Caregivers’ knowledge of the minimum working age, working hours and types of work which are legally allowed in Lebanon for children 61% of Syrian respondents in ISs believed the minimum working age by law to be 18 years or more. 25% were unsure about the legal minimum working age while 14% believed it to be at 17 years and younger. 74% of Syrian respondents in ISs believed the maximum number of working hours to be 7-10 hours per day, 11% believed 6 hours while 5% believed over 10 hours. The type of work that Syrian respondents in ISs believed children to be allowed to work in the most is in shops at 84%, while the second-most is in mechanics and garages at 79%, directly followed by agriculture at 78%. In contrast, 98% of respondents stated that street work or begging was not a type of work allowed for children, followed by construction work at 60%. Type of work

Yes

No

Street work/ begging

2%

98%

Construction

40%

60%

Mechanics/ garages

79%

21%

Shops

84%

16%

Domestic work

60%

40%

Agriculture

78%

22%

Table 7.40: Types of work Syrian respondents in ISs believe children above the minimum working age are legally allowed to work in Knowledge on positive discipline 63% of Syrian respondents in ISs stated that it is wrong to hit children, indicating knowledge on alternative non-violent methods of discipline. Around 30% stated that hitting children can be justified depending on the circumstance while 7% believed that hitting children was not wrong. In FGDs, Syrian women in ISs explained that nowadays it is necessary to hit children as they had become desensitised to violence, which is omnipresent in school, with friends and at home. “Nowadays, children only understand violence. Boys get hit more than girls because girls are generally quieter.” Syrian woman, FGD in an IS in Bekaa, May 2017

Attitudes on positive discipline 82% of Syrian respondents in ISs exhibit favourable attitudes on positive discipline methods as they believe them to be useful. The positive discipline method that was perceived the most useful by Syrian

184 respondents in ISs was explaining to the child why his or her behaviour was wrong at 96%. Shouting at the child as a method for discipline was perceived at useful by 43% of respondents, while spanking, hitting or slapping the child on the bottom was stated as useful by 30% of respondents. Disciplining methods

Useful

Not useful


96%

4%


80%

20%


69%

31%


16%

84%

Shout at child

43%

57%


30%

70%


14%

86%

Table 7.41: Syrian respondents in ISs’ attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue)

7.3.5. Palestine refugees’ domain Knowledge on protection risks Palestine refugees stated an average of 3.5 responses on protection risks for boys and almost 4 responses for protection risks for girls. Asked about when boys are in risk of danger in their environment, most Palestine refugee respondents perceive that to be when boys’ basic needs are not met at 52%; 41% believe that the lack of access to school or healthcare services presents a protection risk, followed by verbal harassment at 37% and physical and sexual harassment at 28%. For girls, the most perceived protection risks pertained to basic needs not being met at 50%, no access to school and healthcare services and verbal harassment at around 40% and physical and sexual harassment at 30%. Exploitation and abandonment of girls were mentioned by 20% of respondents respectively.

185

2% 8% 9%

15% 15% 16% 18% 15% 13% 13% 16% 14% 20% 19%

Don’t know Substance abuse Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

28%

37%

41%

52%

Abandonment by parent or caregivers Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

Table 7.42: Attitudes towards protection risks for boys by Palestine refugee respondents Qualitative findings nuance the above-stated numbers. Palestine refugee participants in FGDs mentioned accessing UNRWA’s basic services including UNRWA schools and healthcare centres. As a Palestine refugee mother put it, enrolment in school is also not an issue but the retention in school is. Mothers mentioned that the lack of skilled work opportunities due to Palestine refugees’ legal work limitations reduce young people’s ambitions to pursue their education. Moreover, the perception is that only basic healthcare services are covered and uncertainty exists around what treatments UNRWA can cover, such as for chronic diseases or hospitalisation. It is therefore likely that Palestine refugee respondents’ regarding lack of access to school or healthcare referred to a perceived reduced level of access.

186

1%

5% 7% 7%

19% 11%

19% 16% 14% 15% 15% 12% 15% 18% 19% 21%

30%

Don’t know Abandonment by parent or caregivers Child marriage Exploitation Working in the streets Sexual violence in the community Physical violence in the community Verbal violence in the community Physical/sexual harassment No access to school or to health care

38% 39%

50%

Prostitution Substance abuse Peer pressure and bullying Child labour Sleeping in the streets Sexual violence in the home Physical violence in the home Verbal violence in the home Verbal harassment Basic needs not met (food, shelter, clothing)

Table 7.43: Attitudes towards protection risks for girls by Palestine refugee respondents Knowledge of harmful consequences of child marriage When asked at what age girls usually get married in their communities, only 36% of Palestine refugee respondents stated by 20 years and over. 33% believe that girls get married by 18 years, 23% by 16 years and 7.5% by 14 years. However, more female respondents than male state lower the ages: for instance, while 11% of the female respondents state that girls get married by 14 years of age, 4% of male respondents’ state so. Crucially, these numbers are respondents’ perception, which might differ from the actual practice.

30% 33% 25%

Female

11% 1% 42% 33% 21%

Male

4% By 20 years and over

By 18 years

By 16 years

By 14 years

By 12 years

Table 7.44: Perceived age at which girls usually get married cited by Palestine refugee respondents

187 62% of Palestine refugee respondents believe that marriage under the age of 18 years has negative consequences. While 15% of respondents were unsure whether marriage under the age of 18 years has any negative consequences, 16% stated that child marriage had no negative consequences. Of the 77% of Palestine refugee respondents who believed that child marriage has or might have negative consequences, almost 60% cited health risks on the mother during pregnancy and almost 40% during birth. Moreover, almost 40% believed that child marriage would limit education or work opportunities and 35% believed that it increased risk of domestic violence. “I married at a very young age and against my parents’ wishes. I still think it is more likely that you may not choose the right partner and that it is physically damaging to have children that young.” Palestine refugee female caregiver, FGD in Beirut, May 2017 In the qualitative data, Palestine female respondents were some of the few FGDs participants to explicitly cite health risks as a result of child marriage. Moreover, they highlighted the increased social risks such as the risk of separation and divorce as a result of marrying too early. While risks of child marriage where more or less known, FGDs participants stressed that the practice was still ongoing in their community, especially among young people who fall in love. Early divorce Young

1% 5%

DK

2%

Increased risk of and exposure to domestic violence, Mother not accessing opportunities such as work or education Threat on psychological wellbeing of mother,

35% 38% 27%

Threat on baby’s life (prematurity, low birth weight, developmental delays/disorders) Threat on foetus life

23% 17% 34%

Life-long health consequences for the mother

40% 58%

Threat on mother’s life at birth Threat on mother’s life during pregnancy

Table 7.45: Reasons cited by Palestine refugee respondents who believe that child marriage has or might have negative consequences Knowledge on how to report CP and GBV violations If a woman in the community was a victim of violence, 88% of respondents stated that she would inform someone or report the case, while 12% believe she would do nothing about it. When asked who she would report to, 20% of Palestine refugee respondents stated that a woman would report a case of GBV to formal authorities, namely to NGOs or local authorities. 13% of male respondents and 24% of female respondents believe that a woman would report an incident of violence to formal authorities. Overall, 58% of female and 68% of male respondents believe that a woman would resort to the immediate family to report a protection issue, namely to the husband or parents/caregivers, indicating a trend of relying on informal networks.

188

1% 1% 8% 4%

Female

1% 1% Male

12% 21% 19% 20%

7% 13% 6% 8% 13%

75%

23%

87%


Report to nobody




Report to an NGO




Table 7.46: Palestine refugee respondents’ attitudes on whom a woman would inform regarding a protection issue for herself by gender If Palestine refugee respondents saw or heard that a child they knew was in a situation of danger, 95% stated that they would inform someone or report the case. 26% of Palestine refugee respondents stated that if they had to report a protection issue for a child, they would report it formal authorities, namely to NGOs or to local authorities. 17% of male respondents would do so, compared to 32% of female respondents, with more women showing a willingness to access NGOs. 54% of female respondents and 62% of male respondents would report to the child’s caregivers or to neighbours and friends. Crucially, Palestine refugees access NGOs that are located inside the camps and cater to them, but might be affiliated with certain political factions.

1% Female

1% Male

13%

7% 6% 7%

26% 23%

9% 7% 4%

67%

16%

13%

25%

88%


Report to nobody




Report to an NGO



189

Table 7.47: Formal and informal actors Palestine refugee respondents would inform about a protection issue for a child under 18 years by gender Positive attitude towards seeking CP, GBV and other services through NGOs 56% of Palestine refugee respondents believe that protection services provided to children and women through NGOs are helpful. In contrast, 21% of respondents do not believe that they are useful, 15% are undecided and do not know and 4% believe that the services were not needed. Women had a higher affirmative response rates towards seeking services through NGOs than men, at 62% compared to 32%. Moreover, 21% more men than women did not know whether the services were useful, indicating a lack of knowledge on, and involvement of, men in protection issues for women and girls.

5% Female

Male

5%

DK

8%

25%

62%

26% 18% Services are not needed

51% No

Yes

Table 7.48: Palestine refugee respondents who believe protection services provided to children and women through NGOs are useful by gender

Attitudes of community members on participation of minors in armed violence When asked in which circumstances the participation of children under 18 years in armed violence was justified, 87% of Palestine refugee community members answered that it was not justified under any circumstances. Comparatively, 9% argued that it was justified when the community was under threat or attack. Male respondents were slightly more in favour of children’s participation in armed violence at 83% compared to 91% for female respondents. Caregivers’ knowledge of the minimum working age, working hours and types of work which are legally allowed in Lebanon for children 76% of Palestine refugee respondents believed the minimum working age by law to be 18 years or more. 8% were unsure about the legal minimum working age while 13% believed it to be at 17 years and younger. 74% of Palestine refugee respondents stated the maximum number of working hours to be 7-10 hours per day, 5% believed 6 hours while 18% believed it to be over 10 hours. The type of work that Palestine refugees believed children to be allowed to work in the most is in agriculture at 69%, while the second-most is in mechanics and garages at 64%. In contrast, 98% of

190 respondents stated that street work or begging was not a type of work allowed for children, followed by construction work at 77%. Type of work

Yes

No

Street work/ begging

2%

98%

Construction

23%

77%

Mechanics/ garages

64%

36%

Shops

53%

47%

Domestic work

55%

45%

Agriculture

69%

31%

Table 7.49: Types of work Palestine refugee respondents believe children above the minimum working age are legally allowed to work in Knowledge on positive discipline 68% of Palestine refugee respondents stated that it is wrong to hit children, indicating knowledge on alternative non-violent methods of discipline. 22% stated that hitting children can be justified depending on the circumstance while 10% believed that hitting children was not wrong. Female respondents displayed more negative attitudes towards positive discipline, as 26% stated that hitting children can be justified depending on the circumstance compared to 18% of male respondents. Attitudes on positive discipline 73% of Palestine refugee respondents exhibit favourable attitudes on positive discipline methods as they believe them to be useful. The positive discipline method that was perceived the most useful by Palestine refugee respondents was explaining to the child why his or her behaviour was wrong at 91%. Shouting at the child as a method for discipline was perceived at useful by 35% of respondents, while spanking, hitting or slapping the child on the bottom was stated as useful by 32% of respondents. Disciplining methods

Useful

Not useful


91%

9%


80%

20%


51%

49%


12%

88%

Shout at child

35%

65%


32%

68%


8%

92%

Table 7.50: Palestine refugee respondents’ attitudes on disciplining methods relating to positive discipline (in orange), verbal violence (in green) and physical violence (in blue)

191

Bibliography Abdulrahim, Sawsan and Jana Harb. 2015. Profiling the vulnerability of Palestine refugees from Syria living in Lebanon. Beirut: UNRWA. Abla, Zeina and Muzna Al-Masri. 2014. Situation analysis of youth in Lebanon affected by the Syrian crisis. Beirut: UNFPA, UNICEF, Save the Children, and UNHCR. Coalition to Stop the Use of Child Soldiers. 2007. Lebanon: The vulnerability of children to involvement in armed conflict. London: Coalition to Stop the Use of Child Soldiers. Government of Lebanon, and United Nations. 2017. Lebanon Crisis Response Plan 2017-2020. Beirut: Government of Lebanon and United Nations. Hassan, G et al. 2015. Culture, context and the mental health and psychosocial wellbeing of Syrians: A review for mental health and psychosocial support staff working with Syrians affected by armed conflict. Geneva: UNHCR. ILO and UCW. 2014. The twin challenges of child labour and youth employment in the Arab states: An overview. Beirut: International Labour Organization’s Regional Office for Arab States and UNICEF’s Understanding Children’s Work Programme. SGBV Working Group. 2016. Domestic and intimate partner violence - Q3 2016. Beirut: SGBV Working Group. Spencer, R.A. et al. 2015. Gender based violence against women and girls displaced by the Syrian conflict in South Lebanon and North Jordan: Scope of violence and health correlates. Beirut: Alianza por la Solidaridad. UNHCR, UNICEF, and WFP. 2016. Vulnerability assessment of Syrian refugees in Lebanon 2016. Beirut: UNHCR, UNICEF and WFP. UNICEF. 2011. Lebanon. MENA gender equality profile. Status of girls and women in the Middle East and North Africa. Amman: UNICEF Regional Office for the Middle East and North Africa. UNICEF. 2016a. Lebanon Baseline Survey 2016. Beirut: UNICEF. UNICEF. 2016b. The state of the world’s children 2016: A fair chance for every child. New York: UNICEF. UNICEF. 2017a. Child marriage. https://data.unicef.org/topic/child-protection/child-marriage/. Accessed 1 October 2017.

192 UNICEF. 2017b. Protecting children from violence, exploitation and abuse. https://www.unicef.org/protection/57929_57972.html. Accessed 1 October 2017. UNICEF, OCHA, and REACH. 2015. Defining community vulnerabilities in Lebanon. Assessment report September 2014 – February 2015. Beirut: UNICEF, OCHA, and REACH. World Vision. 2013. Stand with me. Ending the war on Syria’s children. Uxbridge: World Vision International.

193

8. CHILD RIGHTS 8.1. Situation analysis 8.1.1. Child Rights policy response All children, like adults, have a right to an acceptable standard of living, access to social services and to a life free from bias and stigma.123 Child rights exist to guarantee the social inclusion of children. Consequently, child rights centre on understanding patterns and drivers of child poverty and exclusion and developing effective responses.124 In its work for child rights and social inclusion, UNICEF establishes partnerships with a variety of actors and across sectors on behalf of the poorest and most marginalised children. UNICEF’s social inclusion approach consists of five focus points: 1. 2. 3. 4. 5.

Child poverty and social protection Human rights, non-discrimination and participation Public finance for children Governance and decentralisation Social inclusion in humanitarian settings125

The social inclusion programme in Lebanon focuses on promoting awareness and fulfilment of child rights, including children’s involvement in decisions that affect their lives. The KAP Study also scopes the awareness of the National Poverty Targeting Programme (NPTP) A literature review on KAP indicators under social cohesion rendered no relevant data, which is why the indicators are presented without further introduction.

8.1.2. Baseline indicators Knowledge of child rights Knowledge of child rights is a critical condition for their fulfilment. The first indicator under child rights therefore assesses the % of men and women who have heard of child rights across population domains.

123

UNICEF 2015: 3.

124

UNICEF 2014; see also ESCWA 2009.

125

UNICEF 2014.

194 Duty bearers’ awareness of role in safeguarding child rights Fulfilling child rights requires awareness on the part of duty bearers (parents, caregivers, teachers, healthcare professionals, community leaders, authorities, etc.) as to their respective role in safeguarding children’s rights.126 The second KAP indicator therefore is: % of duty bearers, (i.e. caregivers and community members, i.e. leaders, teachers, doctors, nurses, social workers) aware of their role as promoters/protectors of child rights. Duty bearers’ attitudes towards preventing rights violations Preventing child rights violations relies for a large part on the positive attitudes of duty bearers. The third KAP indicator is: % of duty bearers with positive attitudes towards preventing child rights violations. Children’s involvement in decision-making Policies and programmes are supposed to serve the best interest of the child (article 3 of the Convention on the rights of the child or CRC). Article 12 of the CRC grants children ‘the right to express [their] views freely in all matters affecting the child’.127 Children’s involvement in decision-making is also a foundation for child rights governance. The relevant qualitative KAP indicator is: boys and girls who are involved in decision-making processes affecting them. Children feel they are listened to Programmes and policies may consult children during design, implementation and evaluation, but whether children experience that they have actually been listened to is a different concern. The qualitative KAP indicator under child rights focuses on children’s subjective experience of participation in decision-making: boys and girls who feel like they are listened to in matters relevant to them. Awareness of National Poverty Targeting Programme “As rates of poverty incidences increase, certain members of a family – children and older persons, persons with specific needs and female-headed households – become more vulnerable to exclusion, exploitation and increased hardships” 128 Data from 2008 and 2011 suggest that between 27% and 28.5% of Lebanese were poor prior to the start of the Syria crisis. Around 10% of the population was considered extremely poor. In response, MOSA initiated the National Poverty Targeting Programme (NPTP) in 2011.129 Following the start of the Syria crisis, poverty rates have increased by 6%. Upon adding a food voucher component to NPTP in November 2014, an increase in the number of applications to the NPTP programme was noticed by MOSA, partly as a result of Lebanese returnees from Syria. By the end of 2016, 105,849 households were deemed to live below the poverty line and hence to be eligible to receive NPTP assistance. Nearly a third of these households live below the absolute poverty line. Eligible households receive health and education subsidies and food assistance through e-vouchers.130

126

See also UNICEF 2017.

127

United Nations 1989.

128


129

Ibid. See also Kukrety 2016: 18-20.

130


195 The final KAP indicator under child rights is: % of Lebanese households who are aware-of and trust National Poverty Targeting Programme (NPTP) to target and serve the most vulnerable households.

8.2. Qualitative findings overview 8.2.1. Supply and demand of services HCC Lebanon’s Higher Council for Childhood or HCC was established in 1994 and is formally part of MOSA. It represents the national framework for the work on child development and wellbeing in compliance with international conventions, especially with the CRC. HCC’s work is concentrated on the level of policy and strategy at the national level, including coordination between ministries and NGOs, capacity building and trainings for various stakeholders and reviewing law bills and advocacy proposals. HCC had a clear policy of not working in the Syria crisis emergency response, maintaining a constant line of priorities and outcomes and not going down the route of humanitarian programming and service delivery. Syrian children living on Lebanese soil, however, are included in the mandate of HCC, but without being singled out or targeted separately. In practice, HCC works on certain specific issues at a time and invests its resources more in activities in the field. For example, HCC led a campaign against cyberbullying with a TV spot, 5 billboard ads and 1,000 goodie bags, all provided as donations from various companies. Before the Syria crisis, HCC undertook community work with children caught in armed fighting in Tripoli, work that stemmed from a jointly developed action plan with UNICEF. Moreover, HCC implemented a child parliament project in partnership with UNICEF and a few other NGOs, focusing on citizenship education for Lebanese children from different areas of the country. HCC also provides training and capacity building for the government, NGOs and schools, reviews law bills and works on campaigns. In addition, HCC has a coordinating role and leads 17 different committees with NGOs, UN and government partners. While HCC is a critical player in pursuing sustainable, policy-based and development-oriented programming on child rights in Lebanon, it does not currently have a national strategy, which is a challenge in targeting efforts and resource allocation for child rights. Duty bearers The qualitative data collection focused on duty bearers’ attitudes to protecting and upholding child rights across different sectors including education, health and child protection. Overall, the picture is mixed. Across KIIs and FGDs, the importance of child rights was acknowledged yet overshadowed by the actual and reported pervasiveness of verbal, psychological and physical violence both inside and outside the home. Violence is omnipresent across society and escalates among vulnerable populations. Parents’ and caregivers’ role as primary duty bearers is overwhelmingly recognised across the country and across all three surveyed nationalities. Moreover, educators’ role as duty bearers is highly recognised in Lebanon. Parents place a great amount of trust and expectation on educators, in particular on teachers and school principals. In the FGDs, however, parents often lamented the lack of care from educators for their children’s learning and development. Children also do look up to their educators as role models, but cases of corporal punishment or lack of capacity or interest on the part of educators present a challenge. Overall, the picture in Lebanon is mixed as not all educators seem to be aware of their role as promoters and protectors of child rights. While some school principals and educators interviewed for

196 the KAP Study articulated a high awareness of their role as duty bearers, comments from caregivers and children who participated in FGDs seem to suggest that a lack of awareness is widespread. On the other hand, medical professionals are not perceived as duty bearers the same way as educators; doctors and nurses are first and foremost seen as service providers. Children especially do not seem to have a relation of trust with them.

8.2.2. FGDs summary Beirut Lebanese boys

Mount Lebanon Lebanese mothers

Akkar

North

Bekaa

Syrian fathers (IS)

Syrian boys

Lebanese mothers

BaalbekHermel Lebanese fathers

South

Nabatieh

Syrian mothers

Lebanese girls

Table 8.1: Child rights FGDs matrix During the FGDs on the topic of child rights, respondents shared their views on what they believed to be the rights of children, how the current socio-economic situation is impacting them and to what extent boys and girls participate in decision-making. As part of the discussion, respondents also expressed their opinions on the ages or stages in life when children become adults, which provides a qualitative baseline that puts data on child rights into perspective. The majority of caregivers and all the children spoken to were familiar with the concept of child rights, although the majority stated not having had any information provided to them on the topic in a formal way. Lebanese mothers in the Bekaa stated receiving information from TV programmes, advertisements by NGOs and their children’s schools on child rights. The only population group that showed limited knowledge on the topic were Syrian fathers in an IS in Akkar, who, when asked about child rights, did not elaborate on anything specific. “If we cannot afford giving the child his right, we need to explain the reason or excuse to him.” Lebanese mother, FGD in Bekaa, June 2017 All Lebanese caregivers, and Syrian female caregivers except in Akkar, state children’s basic rights such as the right to shelter, clothes, food, healthcare, education, play and to get love and affection from their parents. Lebanese caregivers also mentioned the right to socialise and participate in activities, emphasising entertainment, communication with other children and developing social skills. Moreover, they stated that children have the right to express themselves and to voice their opinion, to change their minds and to develop their personalities. While Lebanese fathers in Baalbak-Hermel stressed the importance of education and aspiring to see their children attend university, Syrian mothers in the South insisted that it is children’s right not to have to work. Gender came out strongly in all FGDs and centred on the difference in decision-making varied between boys and girls. Girls are more or less expected to model on their mothers and boys to model on their fathers. Boys were argued to benefit more from freedom than girls, including being able to work independently or staying out late. Girls were perceived to face more personal safety and security issues, making it necessary to keep them at home. Boys have more opportunities to participate in organised group activities, to move to Beirut or abroad to pursue higher education and more choice in deciding on who and when to marry than girls. Interestingly however, protection issues for boys are increasingly being recognised by all respondents, including social pressure that can be placed on them to earn an income. Qualitative gender findings will be examined in more detail per domain in the sections below.

197 In addition to gender, respondents’ social and economic status seems to play a role in their level of knowledge, attitudes and practices. For instance, Lebanese mothers spoken to in Mount Lebanon, who were from a middle-income background, expressed more positive attitudes and reported more positive practices on child rights than Lebanese caregivers in other mohafazat, and than Syrian caregivers. Levels of knowledge, attitudes and practices are also tightly coupled to vulnerability levels, including housing situation, legal status and financial precariousness. Syrian caregivers who participated in FGDs and who were living in ISs and in collective shelters showed the highest levels of vulnerability when it came to protecting child rights. “I would let the boy go to Beirut to study but I would not let the girl go and sleep in a dormitory.” Lebanese father, FGD in Baalbak-Hermel, June 2017 Caregivers all stated that they were primarily responsible to ensure that the rights of their children are respected and fulfilled. The discussion centred mostly on caregivers’ own children and the duties they had towards them directly, rather than children in general. In addition to considering themselves as mainly responsible for their children, Lebanese fathers noted that the state and NGOs are also responsible to protect child rights, especially when it comes to education and health, although in their opinion the state was largely absent in their lives. In contrast, when asked who is responsible for protecting child rights, Syrian mothers in the South did not mention anyone outside the immediate family, with the exception of teachers and healthcare workers who they thought also should be involved as duty bearers. KIIs with duty bearers across the country do show that knowledge on child rights is prevalent, however, the consent and role of parents remains vital and can rarely be circumvented. “In Syria, the children’s uncles would help them with homework, but here in Lebanon the children are not able to benefit from such educational opportunities.” Syrian mother, FGD in South, June 2017 Caregivers strongly express their responsibility in fulfilling child rights, although related primarily to their own children. Situations in which parents cannot protect their children’s rights are related to the socio-economic situation and are of a structural nature. Syrian mothers in the South, for instance, mentioned that children’s rights were not protected in situations of displacement, stressing that children could not be granted the fundamental right to education. In Lebanon, Syrian families have lost the essential support network of the extended family. Lebanese parents, on the other hand, mention economic stagnation and scarcity of jobs as a reason for why children and youth might have to give up their right of pursuing an education, by either starting to work or marrying early. Evidence from FGDs also highlights the prevalence of corporal punishment by educators across the country, representing an attitudinal problem of structural scale. Moreover, anecdotal evidence points towards medical professionals providing inadequate medical advice related to infants’ nutrition and health. “Our parents raise us; they help us; they educate us; they care about us.” Syrian boy, FGD in North, May 2017 Overall, Lebanese and Syrian boys as well as Lebanese girls, who participated in the FGDs, felt involved in the decision-making processes affecting them. All perceived to be allowed a certain degree of autonomy in making decisions on friendships and their choice of education and career. Responses by caregivers partly confirmed these statements, but highlighted the structural realities and gender differences once again. For instance, although boys have more freedom of movement, they also face more social pressure to step in to support the family financially if needed. While Lebanese children did not mention that the extended family plays a significant role when decisions are made that affect them, Syrian boys stated specifically that, in addition to their parents, aunts, uncles and grandparents take decisions in the household. Importantly, a discrepancy seems to exist between when caregivers consider children to reach adulthood and when children themselves

198 believe that they become adults. While many caregivers would consider children as more or less adult already at the age of 14-16 years, children seem to think that they become adults only at 18 years and over.

8.3. Baseline indicators: Child rights 8.3.1. All domains Knowledge of child rights 90% of total respondents heard of child rights, while 10% had not. Of those who had heard of child rights, almost 80% associated it with the right to education, 64% with the right to health and 61% with the right to adequate living standards.

% of respondents who heard of child rights

Lebanese residents




Male

89%

91%

77%

73%

Female

92%

92%

76%

88%

Total

91%

91%

76%

81%

Total

90%

Table 8.2: Overview of child rights indicator by domain, gender and in total: percentage of respondents who heard of child rights

78%

Right to education 64%

Right to health Right to adequate living standards (food, shelter, clothing)

61% 57%

Right to life

55%

Right to rest and leisure 30%

Right to be protected from abuse

26%

Right to parental care & support

22%

Right to be protected from exploitation Right to be safe in emergency or in especially difficult circumstances

21% 15%

Right to participate in family and social life DK

3%

Table 8.3: Total respondents’ results when asked what kind of rights they think ‘child rights’ refer to

199

Duty bearers’ awareness of role in safeguarding child rights 96% of duty bearers asked in the KAP Study were aware of their role in safeguarding child rights, by stating parents and caregivers as those who play the most significant role in protecting child rights. The remaining 4% of total respondents cited the state, extended family and siblings.

% of duty bearers who are aware of their role in safeguarding child rights

Lebanese residents




Total

96%

96%

98%

86%

96%

Table 8.4: Overview of child rights indicator of duty bearers who are aware of their role in safeguarding child rights’ results by domain and total Duty bearers’ attitudes towards preventing rights violations 95% of duty bearers have positive attitudes towards preventing child rights violations. When asked to what extent respondents felt it was their duty to protection child rights, whether they have children or not, 83% stated fully and 12% stated to a significant extent. 3% believed that it was their duty to protect child rights only to some extent, 1% to a limited extent and 1% only felt they had to protect their own children.

% of duty bearers who have positive attitudes towards preventing child rights violations

Lebanese residents




Total

95%

94%

94%

96%

95%

Table 8.5: Overview of child rights indicator by domain and total of duty bearers who are aware of their role in safeguarding child rights Caregivers’ attitudes towards children needing to be listened to in matters affecting them 84% of caregivers believe that children, or persons under 18 years of age, should be listened to in matters affecting them. A total of 12% believed that children should be sometimes listened to, while 2% stated it depends on the child’s age.

% of caregivers who believe that children need to be listened to in matters affecting them

Lebanese residents




Male

84%

81%

87%

90%

Female

87%

76%

88%

73%

Total

86%

79%

88%

81%

Total

84%

Table 8.6: Overview of child rights indicator by domain and total of duty bearers who are aware of their role in safeguarding child rights Children’s involvement in decision-making Lebanese and Syrian boys and girls believe that they are given some space in taking their own decisions, although Syrian children cite stronger involvement from parents in decision-making that

200 affects the child. The data collected for this indicator are entirely qualitative, as they consist of children’s responses in FGDs. Respondents in the quantitative household survey had to be at least 18 years. Therefore, children did not participate in the quantitative household survey. Three FGDs were held on child rights with children: one with Lebanese boys in Beirut, one with Syrian boys in the North and one with Lebanese girls in Nabatieh. All child respondents were between 12 and 14 years of age. Children feel they are listened to Lebanese boys and girls said that their parents listen to them in matters that are important to them, while Syrian boys felt that their parents did not always listen to them in matters that are important to them. The data collected for this indicator are entirely qualitative, as they consist of children’s responses in FGDs. Respondents in the quantitative household survey had to be at least 18 years. Therefore, children did not participate in the quantitative household survey. Three FGDs were held on child rights with children: one with Lebanese boys in Beirut, one with Syrian boys in the North and one with Lebanese girls in Nabatieh. All child respondents were between 12 and 14 years of age. Awareness of National Poverty Targeting Programme (Lebanese only) 27% of Lebanese households were aware of the NPTP, in contrast to 73% who were not. Of those respondents who were aware of the NPTP, 51% believed that it effectively targets and serves the most vulnerable households, compared to 32% who did not believe so and 17% who were unsure.

% of Lebanese households who are aware of the NPTP

Beirut

Mount Lebanon

North and Akkar

South

Nabatieh


Total

Male

38%

31%

25%

34%

21%

31%

31%

Female

20%

22%

28%

39%

11%

25%

25%

Total

27%

26%

27%

37%

15%

26%

27%

Table 8.7: Overview of child rights indicator of Lebanese households who are aware of the NPTP by gender and mohafaza

8.3.2. Lebanese domain Knowledge of child rights 91% of Lebanese male and female respondents heard of child rights in contrast to 9% who had not heard of child rights before. Of those who heard of child rights, 81% associated it with the right to education, almost 70% with the right to health, 60% with the right to adequate living standards and to life. Almost 60% mentioned the right to rest and leisure, such as playing. Lebanese stated the right to participate in family and social life, which, at 17%, is the highest percentage compared to other domains. “Sometimes children lead and other times they follow.” Lebanese female caregiver, FGD in Mount Lebanon, May 2017 All Lebanese caregivers spoken to in FGDs stress the right to education as a major one, and explained that issues related to the lack of education are often related to financial difficulties or to the family environment. Healthcare was also mentioned as a major right among caregivers, who mentioned that necessary medical treatment was not always provided in Lebanon. Lebanese respondents were aware of the need to let children express themselves as it could otherwise impact children negatively.

201 DK Right to participate in family and social life

2% 17%

Right to be safe in emergency or in especially difficult circumstances

22%

Right to parental care & support

27%

Right to be protected from exploitation

23%

Right to be protected from abuse

31% 61%

Right to adequate living standards (food, shelter, clothing)

57%

Right to rest and leisure

81% 68% 60%

Right to education Right to health Right to life

Table 8.8: Answers given by Lebanese respondents when asked what ‘child rights’ refers to Duty bearers’ awareness of role in safeguarding child rights 96% of respondents and duty bearers are aware of their role as promoters and protectors of child rights and believe that parents and caregivers play the most important role in safeguarding child rights. The other 4% believe that the state and siblings should have the main role in protecting child rights. Data from FGDs highlight that although caregivers are aware of child rights, in practice gender norms play a crucial role in how they are promoted and protected. Generally, the right to education and to social life seem to be more promoted for boys, although boys also need to step in to support the family financially if need be. Among Lebanese respondents, education is increasingly valued for girls as, it is argued, it can support them in case of economic adversity, it develops their sense of self and it helps their children later in life. “In our society, women who work and who will not worry whether their husband earns money or not are increasingly being valued.” Lebanese female caregiver, FGD in Bekaa, June 2017

Duty bearers’ attitudes towards preventing rights violations 95% of duty bearers had positive attitudes towards preventing child rights violations, as they felt it was their duty to protect child rights to a full (84%) and to a significant (11%) extent. Only 2% felt it was their duty to protect child rights to some extent, and 1% felt that they should protect only their own children.

202

1% 1% 2% 11% 84% Only my own children

To a limited extent

To some extent

To a significant extent

Fully

Table 8.9: Lebanese respondents who feel that it is their duty to protect child rights, whether they have children or not. Caregivers’ attitudes towards listening to children in matters affecting them 86% of Lebanese caregivers stated that children should be listened to in matters affecting them. In contrast, 11% stated that children should sometimes be listened to, while 2% stated it depended on the child’s age. The indicator below elaborates on the qualitative findings. Children’s involvement in decision-making Lebanese boys and girls believe that they are given some space in taking their own decisions. Such decisions concern the choice of friends, degree of socialising with people that the parent’s trust and choice of future profession and career paths. Parents are seen to ‘advise’ their children based on what they believe the be the best for them. Some boys mention having strict fathers who limit the scope of social activities and of mobility with friends and only allow going out with family members. Lebanese girls stated that they trust their mothers and seek their support and advice in personal matters, unlike boys who did not provide any information in this regard. Lebanese girls stated explicitly that the reason they take their parents’ advice is that they know more than them and know what is good for them. Child rights are known by children and said to be the responsibility of parents until children are 18 years of age. “If my parents know who we are with and transport is available, then they will let me go to an activity.” Lebanese boy, FGD in Beirut, May 2017 Lebanese caregivers’ responses seem to validate children’s statements. Lebanese mothers in Mount Lebanon and Bekaa, as well as fathers in Baalbak-Hermel, demonstrated a certain level of awareness of children’s right to participate to some degree in decision-making. Lebanese mothers in Mount Lebanon from middle-income households exhibited the most progressive perspective among respondents, encouraging children to voice their opinions and asking their children to participate in decision-making, which, for boys, can include buying a new house or a car and, for girls, buying furniture and changing the interior of the home. It seems especially important for Lebanese parents to instil in their children a sense of integrity, so that they can stand up for themselves. “My daughter would not let anyone touch her or pat her on the head in school, not even teachers or supervisors. She would say ‘ne touche pas’, as she was taught at home.” Lebanese mother, FGD in Mount Lebanon, May 2017 As the scope of decision-making expands, gender differences become apparent. Lebanese mothers in the Bekaa stated that society distinguishes genders and that boys are given more freedom. Lebanese fathers confirmed this statement, by explaining that while girls can only participate in lower-level decisions, boys can already take major life decisions, including joining an armed group, leaving the home or eloping to marry a girl before the age of 18 years. On education, Lebanese fathers would be

203 reluctant to send daughters to pursue further studies in Beirut, whereas they would not mind sending their sons. Lebanese mothers in Mount Lebanon would similarly be more reluctant to allow their daughters to study outside the country than they would with their sons. Parents’ comments point towards a positive societal trend, however: increasingly, girls pursue education, develop strong characters and make a living on their own. “We wear the headscarf. It is obligatory but I do not force my daughter. I explain the reasons for wearing the headscarf to her, but do not force her.” Lebanese mother, FGD in Bekaa, June 2017 Parents do, in part, have a say in their children’s choice of work, especially when asking boys to support the family financially. Parents seem to expect sons to support them financially. Sons might be asked to start working at an early age if necessary. Although boys and girls can in principle choose their own partners, parents state that for their daughter they investigate more thoroughly a possible groom, including his financial means, whether he owns a home and is educated. For boys, on the other hand, it is enough if the bride is decently behaved for her to be accepted. Regarding headscarves, caregivers’ practices differ as some mothers would oblige a child to wear the headscarf while others would use persuasion and not insist if their daughter does not want to wear it. Children feel they are listened to Lebanese boys and girls perceived their parents to listen to them in matters that are important to them. Boys stated that their parents took good care of them and that they felt their child rights were being met. Girls would especially turn to their mothers to seek their advice and tell them about their personal relationships. They mentioned seeking their fathers’ advice when facing a problem with someone or wanted to go out with friends (seeking permission). Child respondents admitted that parents do not listen to everything they tell them, or that there are matters that they would prefer not to tell their parents, in particular if it involved romantic relations or having done something ‘wrong’ with friends. Regarding other duty bearers, boys mentioned that there were some school teachers they really trusted and would speak to, whereas they did not trust others. “My father listens to me and is open-minded.” Lebanese boys, FGD in Beirut, May 2017 Lebanese mothers in Mount Lebanon backed up the views of children respondents and stated that dialogue was the basis of the relationship between their children and them. They were focused on building their children’s character and decision-making abilities. Parents send children out to buy things from the store or encourage them to choose their own clothes. They sometimes force them to visit relatives or take part in religious observances but underscore the importance of compromise and dialogue. Mothers perceive girls as being more attentive while boys are considered more headstrong, although, in the end, it depends on individual personality. “We sometimes impose but we compromise…One day is this …One day is that (activity children want to do).” Lebanese mothers, FGD in Mount Lebanon, May 2017

Awareness of National Poverty Targeting Programme 27% of Lebanese households are aware of the NPTP, in contrast to 73% who are not. Of those respondents who are aware of the NPTP, 51% believe that it effectively targets and serves the most vulnerable households, compared to 32% who did not believe so and 17% who were unsure.

204

South

37%

North

71%

29%


63%

74%

26%

85%

15%

Bekaa

77%

23%

Beirut

73%

27%

Baalbek-El Hermel

70%

30%

Akkar

76%

24% No

Yes

Table 8.10: Lebanese respondents, by mohafaza, who are aware of the NPTP

18% 33%

Female

49% 4% 31%

Male

65% DK

No

Yes

Table 8.11: Lebanese respondents by gender who believe that the NPTP effectively targets and serves the most vulnerable households

205

56 yrs and over

33%

13%

53% 18%

36-55 yrs

33%

18%

26-35 yrs

33%

8%

18-25 yrs

48%

49%

34%

DK

No

58%

Yes

Table 8.12: Lebanese respondents, by age, who believe that the NPTP effectively targets and serves the most vulnerable households

8.3.3. Syrians registered with UNHCR domain Knowledge of child rights 91% of registered Syrian male and female respondents heard of child rights in contrast to 9% who had not heard of child rights before. Of those who heard of child rights, almost 70% associated it with the right to education, 65% with the right to adequate living standards and 50% with the right to rest and leisure and to health. Only 10% of registered Syrian respondents referred to the right to participate in family and social life.

DK

3%

Right to participate in family and social life

10%

Right to be safe in emergency or in especially difficult circumstances Right to parental care & support

17% 24% 19% 27%

Right to be protected from exploitation Right to be protected from abuse

65% 51% 68% 52%

42%

Right to adequate living standards (food, shelter, clothing) Right to rest and leisure Right to education Right to health Right to life

Table 8.13: Answers given by Syrian respondents registered with UNHCR when asked what ‘child rights’ refers to

206

Syrian respondents in FGDs were generally aware of the basics of child rights and considered childhood to be the best time of a person’s life, without worries or responsibilities. They acknowledged, however, that children are living through difficult times these days with a total absence of rights. Syrian parents expressed their frustration with not being able to provide clothes and toys for their children, and for needing children to support the household financially. Duty bearers’ awareness of role in safeguarding child rights 96% of registered Syrian respondents and duty bearers are aware of their role as promoters and protectors of child rights and believe that parents and caregivers play the most important role in safeguarding child rights. The other 4% believe that the state and siblings should have the main role in protecting child rights, but 1% does not know whose responsibility it is. Duty bearers’ attitudes towards preventing rights violations 94% of duty bearers have positive attitudes towards preventing child rights violations. 81% feel that it is their duty to fully protect child rights and 13% that it is their duty to a significant extent. Only 1% of respondents think it is their duty to protect child rights to some extent, and just as many believe that they should protect just their own children. 3% were unsure how to respond.

1% 1% 1% 3% 13% 81% Only my own children To some extent

To a limited extent To a significant extent

Don’t know Fully

Table 8.14: Syrian respondents registered with UNHCR who think that it is their duty to protect child rights, whether they have children or not Caregivers’ attitudes towards listening to children in matters affecting them 79% of registered Syrian caregivers with UNHCR stated that children should be listened to in matters affecting them. In contrast, 16% said that children should sometimes be listened to, while 4% said that it depends on the child’s age. The indicator below elaborates on the qualitative findings. Children’s involvement in decision-making Syrian boys spoken to in the North of Lebanon were more vocal on the decision-making structure within the family, including the roles of parents, uncles and aunts, and grandparents. Boys stated that their parents ensure that they are safe and would not hurt each other, that they stay clean and tidy, behave well and study hard. Uncles seem to guide children towards pursuing education and supporting parents where possible. Grandparents seem to have a say in family affairs in an advisory fashion, because they are assumed to have accumulated enough experience to base their advice on. Regardless, the boys state that parents are the primary reference for them and the first people they would go to for help. Parents seem to have authority over which decisions children can participate

207 in and make in their lives. The boys have to obtain their parents’ permission before going out to an activity or meeting with friends. “My school football team was the first public school to win the national championship and all the winners had been granted a scholarship to attend the final match. Although I was supposed to participate in the final match, my mother did not let me go because it was held in Beirut.” Syrian boy, FGD in North, May 2017 Syrian mothers in the South, who are struggling financially, corroborate that children can participate in decisions concerning them. However, they seem to provide more choice to their children than Lebanese parents regarding working alongside school, leaving school to start work and getting married. The respondents acknowledge that because of socio-economic pressure, boys and girls mature earlier than before, which is reflected in the marriage age that ranges between 13 and 20 years. Boys are asking to leave school to work and support the family financially, while girls are asking to get married to help reduce their parents’ expenses. “My 11-year old son goes to school but works for an hour a day in an aluminium company.” Syrian mother, FGD in South, June 2017 Gender divisions in decision-making were more starkly expressed by Syrian fathers who participated in an FGD in a northern Akkar IS. They stated that girls participate less in life decisions than boys as a result of customs. Protection issues such as harassment were cited as the reason why girls could only go to school when accompanied by their brothers or male relatives, and otherwise stay within the remit of the IS. Girls’ decisions were mostly limited to household chores, whereas boys can move freely, work and make decisions together with their fathers. On marriage, fathers proclaimed not to force their daughters to accept a certain groom, but that their approval as fathers was necessary for their daughter to marry. Children feel they are listened to While Syrian boys said that they trust their parents and seek their support in different matters, they also stated that there are some issues their parents are not interested in hearing about, such as problems with their friends. The boys expressed a strong desire for more outdoor activities and pursuit of hobbies and interests. They felt that adults do not pay special attention to certain needs of children. All boys mentioned enjoying sports such as football, swimming and bicycling. Syrian mothers in the South commented that they take their children’s decisions seriously. They are aware that children should enjoy their childhood, but that parents often do not have a choice but to encourage children to grow up faster than they normally would. “While our parents are on the Internet, they do not listen to us.” Syrian boy, FGD in North, May 2017 Moreover, parents might not have the financial means to offer boys the kind of social and outdoor activities that they would prefer. The data indicate that young girls and boys take decisions for the sake of the family’s wellbeing, and that difficult socio-economic circumstances are putting a strain on relations between parents and children. Parents are often unable to offer their children the quality of education, healthcare, activities, etc., that parents believe their children to be entitled to. At the same time, children do not want to burden their parents and therefore voluntarily assume the role and responsibilities of adults. “Children today do not play, have become refugees and are far away from their families.” Syrian mother, FGD in South, June 2017

208

8.3.4. Syrians in ISs domain Knowledge of child rights 76% of Syrian male and female respondents in ISs heard of child rights in contrast to 24% who had not heard of child rights before. Of those who heard of child rights, 74% associate it with the right to life, almost 70% with the right to education and 50% with the right to health. 14% of Syrian respondents in ISs mentioned the right to participate in family and social life. DK

12%

Right to participate in family and social life Right to be safe in emergency or in especially difficult circumstances Right to parental care & support

6% 7% 8% 8%

Right to be protected from exploitation Right to be protected from abuse

15%

Right to adequate living standards (food, shelter, clothing) Right to rest and leisure

54% 44% 69% 49% 36%


Table 8.15: Answers given by Syrian respondents in ISs when asked what ‘child rights’ refers to Duty bearers’ awareness of role in safeguarding child rights 98% of Syrian respondents in ISs and duty bearers are aware of their role as promoters and protectors of child rights and believe that parents and caregivers play the most important role in safeguarding child rights. The other 2% believe that siblings and extended family should have the main role in protecting child rights. Duty bearers’ attitudes towards preventing rights violations 95% of duty bearers had positive attitudes towards preventing child rights violations. 72% think it is their duty to fully protect child rights and 23% that they should protect child rights to a significant extent. 4% believe it is their duty to protect child rights to some extent and 1% to a limited extent and 1% are unsure.

209

1% 1% 4% 23% 72% To a limited extent

Don’t know

To some extent


Fully

Table 8.16: Syrian respondents in ISs who think that it is their duty to protect child rights, whether they have children or not Caregivers’ attitudes towards listening to children in matters affecting them 88% of Syrian caregivers in ISs stated that children should be listened to in matters affecting them. In contrast, 12% said that children should sometimes be listened to. Data from FGDs point towards a relatively strict power hierarchy in the family, where older men have more power than women and children. It is perceived that children become adults around 15 to 16 years of age. Since respondents were asked specifically about children as ‘persons under the age of 18 years’, the first number, that is, the rather high percentage at 88%, might be explained by the fact that adolescent children are already perceived as adults.

8.3.5. Palestine refugees domain Knowledge of child rights 81% of male and female Palestine refugee respondents heard of child rights in contrast to 19% who had not heard of child rights before. Of those who heard of child rights, almost 79% associate it with the right to education, followed by the right to adequate living standards at 54% and the right to health at 49%. Only 6% of Palestine refugee respondents referred to the right to participate in family and social life and 12% of respondents did not know exactly what child rights referred to.

210

DK

2%

Right to participate in family and social life

14%

Right to be safe in emergency or in especially difficult circumstances Right to parental care & support

24% 24% 26% 31%

Right to be protected from exploitation Right to be protected from abuse Right to adequate living standards (food, shelter, clothing) Right to rest and leisure

44% 54% 69% 67% 74%


Table 8.17: Answers given by Palestine refugee respondents when asked what child rights refers to Duty bearers’ awareness of role in safeguarding child rights 86% of Palestine refugee respondents and duty bearers are aware of their role as promoters and protectors of child rights and believe that parents and caregivers play the most important role in safeguarding child rights. 7% of Palestine refugee respondents believe that the extended family has the most important role in protecting child rights, whereas 3% of respondents think that the police (ISF) plays the most important role in promoting child rights. 2% say that that it is the responsibility of siblings. Duty bearers’ attitudes towards preventing rights violations 96% of Palestine refugee duty bearers have positive attitudes towards preventing child rights violations. 86% think that it is their duty to fully protect child rights, 10% that it is their duty to a significant extent. 4% said that it was their duty to protect child rights to some extent.

4%

10% 86% To some extent


Fully

Table 8.18: Palestine refugee respondents who feel that it is their duty to protect child rights, whether they have children or not Caregivers’ attitudes towards listening to children in matters affecting them 81% of Palestine refugee caregivers state that children should be listened to in matters affecting them. In contrast, 15% say that children should sometimes be listened to and 3% that it depends on

211 the child’s age. Data from FGDs indicate that respondents in the Palestine refugee domain have different views on when children become adults. Generally, adolescents tend to be perceived as adults at around 15 or 16 years of age. Adolescent boys who are working and earning an income are thought of as being able to take their own decisions to a greater degree than those who are not working.

Bibliography ESCWA. 2009. Social inclusion: Follow-up on priority issues in the field of social development in the ESCWA Region. Beirut: United Nations Economic and Social Commission for Western Asia. Government of Lebanon, and United Nations. 2017. Lebanon Crisis Response Plan 2017-2020. Beirut: Government of Lebanon and United Nations. Kukrety, Nupur. 2016. Poverty, inequality and social protection in Lebanon. Beirut: Oxfam and Issam Fares Institute for Public Policy and International Affairs, American University of Beirut. UNICEF 2014. Annual results report: Social inclusion. https://www.unicef.org/publicpartnerships/files/2014_Annual_Results_Report_Social_Inclusion.pdf. Accessed 26 September 2017. UNICEF. 2015a. 2014 Annual Results Report: Social inclusion. New York: UNICEF. UNICEF. 2015b. Social inclusion of children: The case for support. Accessed 26 September 2017. https://www.unicef.org/publicpartnerships/files/SocialInclusionTheCaseForSupport.pdf. Accessed 26 September 2017. UNICEF. 2017. Child rights toolkit. Integrating child rights in development cooperation. https://www.unicef.org/eu/crtoolkit/ Accessed 26 September 2017. United Nations. 1989. Convention on the rights of the child. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx. Accessed 26 September 2017.

212

9. DISABILITIES

213

9.1. Situation analysis Children with disabilities are among the most marginalized and vulnerable groups worldwide. Confronted with social and cultural exclusion, barriers to accessing services, as well as gaps in policies and legislation, children with disabilities ‘are effectively barred from realizing their rights to healthcare, education, and even survival’.131 The vulnerabilities of persons with disabilities are further augmented in emergency situations, including war and displacement.132 UNICEF works to protect the rights of children with disabilities and mainstream an equity approach worldwide, throughout its policies and programmes.133

9.1.1. Disabilities’ sector response The current Lebanon Crisis Response Plan notes that persons with disabilities ‘are at high risk of violence, discrimination and exclusion. These risks are exacerbated in protracted emergency settings and when there are no targeted interventions in place to aim at reducing inequities for those children living with disabilities’.134 12% of Syrian refugee households and 9% of Lebanese households include one or more members with physical or intellectual disabilities (see also figure 9.1.); 8-10% of the Palestine refugee population has physical or intellectual disabilities135 It is likely that actual rates are substantially higher across domains as persons with disabilities ‘may be hidden in shelters, missed in needs assessments and not consulted in the design of programmes’.136 The WHO estimates that over 15% of any population consists of persons with disabilities137 and this rate is generally higher in conflict-affected populations.138 A data gap persists on disability in Lebanon, which hampers interventions that target children and youth with physical and intellectual disabilities.139 The needs of children with disabilities exceed what service providers can address in terms of rehabilitation services, assistive devices, and mental health care.140 UNICEF’s 2017-2020 Country Programme Document prioritises the inclusion of children with disabilities across sectors. This KAP study sets a baseline to monitor attitudes towards the integration of persons with disabilities in a range of social domains, including education and work.

Age Bracket

Number

%

0 – 17

13,082

13.4%

18 – 24

7,549

7.7%

25 – 34

10,538

10.8%

35 – 64

35,968

36.8%

65+ 30,598 31.3% Total 97,735 100% Table 9.1: Distribution of MOSA disability card holders by age 141 Gender Number % Males 60,148 61.5% Females

37,587

38.5%

Total 97,735 100% Table 9.2: Distribution of MOSA disability card holders by gender142

131

UNICEF 2017. Women’s Refugee Commission 2013: 3. 133 UNICEF 2017. 134 Government of Lebanon and United Nations 2017. 132

135


214

Governorate Beirut Mount Lebanon

Number 7,031 36,144

% 7.2% 37.00%

North Lebanon & Akkar

17,781

18.2%

South Lebanon

12,493

12.8%

Nabatieh 7,993 8.2% Bekaa & Baalbek 16,293 16.6% Hermel Total 97,735 100% Table 9.3: Distribution of PDC holders by mohafaza of Residence143 Type of Disability

Number

%

Motor

58,713

55.3%

Mental

30,376

28.6%

Hearing

9,017

8.5%

Visual 8,009 7.6% Total (including persons with disabilities with 106,115 100% multiple disabilities) Learning difficulties for 2,578 PDC holders Learning difficulties 3,265 without other disabilities Autism 851 Table 9.3: Distribution of MOSA disability card holders by type of disability1

136

Women’s Refugee Commission 2013. World Health Organization 2017. 138 Women’s Refugee Commission 2013: 3; see also Article 19 2015. 139 Government of Lebanon and United Nations 2017: 13. 140 Ibid: 118. 141 Rights and Access Programme - MOSA (November 15, 2016) 142 Ibid. 143 Ibid. 137

215

9.1.2. Baseline indicators Integration in education In order to gain better insight into attitudes towards enrolment of children with disabilities in education, the first set of indicators assesses the % of people who think children with physical disabilities should go to regular preschools and schools and % of people who think children with intellectual disabilities should go to regular preschools and schools. According to the Lebanese government, in 2002, a staggering 85% of children with disabilities did not complete primary education.144 Children with disabilities are met with enormous challenges if they seek to enrol in formal or non-formal education. Most schools report to have no staff or equipment tailored to deal with students with disability needs.145 Lebanese children with disabilities face challenges in pursuing their education. A 2004 survey showed that 38.2% of Lebanese persons with disabilities could not read or write, compared to 11.3% of the general population. A mere 8% of persons with disabilities completed secondary or tertiary education, compared to 32.1% of the overall population.146 None of the displaced Syrian caregivers consulted by the Women’s Refugee Commission reported their children with disabilities as enrolled in formal or informal education. Educating children with disabilities is largely under the mandate of MOSA – instead of MEHE – which operates a number of private schools especially for children with disabilities without the aim of including them into the common system. Directors in MEHE’s public schools are reported to be reluctant to enrol children with disabilities, citing attitudes of parents and lack of equipment. MEHE, however, collaborates with the Lebanese Centre for Special Education to scale up support for children with learning disabilities in public schools.147 Caretakers who have attempted to enrol children with disabilities in non-formal education have likewise reported that schools or learning centres ‘are not equipped for these children and that other students will make fun of children [with disabilities]’.148 Integration into work The second set of indicators assesses the % of people who think young people with physical disabilities should work and % of people who think young people with intellectual disabilities should work. A 2004 survey showed that employment rates for persons with disabilities were lower than those for the general population, despite Lebanese law requiring larger employers to respect a 3% quota for persons with disabilities.149 A 2003 study by the Lebanese Physically Handicapped Union found that over half of the 200 surveyed persons with disabilities (aged 14-38) were unemployed and out of school. A 2007 study of 27,086 working-age persons with disabilities found that only 26 percent were employed.150 Since Syrian refugees are only entitled to work in a limited set of labour sectors (e.g. construction and agriculture), finding work is a major challenge for many displaced families. Due to the scarcity of both legal and illegal work, and the predominantly physical nature of most jobs accepted by refugees, youth with disabilities are confronted with a range of challenges in their search for work and income.151

144

Ibid: 13-14. UNHCR, UNICEF, and WFP 2016. 146 2004 Central Administration of Statistics’ household living conditions survey, quoted in Article 19 2015: 13. 147 Women’s Refugee Commission 2013: 8. 148 Human Rights Watch 2016. 149 Article 19 2015: 13. 150 Ibid. 151 Human Rights Watch 2016. 145

216 Palestine refugees are prohibited to work in 36 professions in Lebanon. Since 2005, Palestine refugees have been granted the right to practice about 70 professions that were previously prohibited to them and restricted to Lebanese nationals only.152 To address challenges confronted by youth with disabilities, the Lebanon Response Plan includes vulnerable people, including children with disabilities, in livelihood activities through specialized training, equipment and devices to allow their full integration in the workforce.153 Integration into society In order to gain better insight into attitudes towards integration of persons with disabilities, the third set of indicators assesses % of people who think children with physical disabilities should be integrated into society and % of people who think children with intellectual disabilities should be integrated into society. “Women, girls and boys with disabilities are among the most vulnerable to neglect, abuse, and exploitation” 154 Families of persons with intellectual impairments are facing extreme challenges and social isolation as refugees. In most cases, the families have had little guidance and support when raising their children in Syria, and have therefore adopted coping strategies that pose protection concerns for the individual in question, particularly when under the added stress of displacement. Some families are using physical and medical restraint to prevent their family members from leaving the shelter and/or harming themselves and others. Stigma and fear of exploitation may also contribute to families hiding their relative, adding to the isolation of the individual.155 As for integration of persons with physical disabilities, MOPH found that three quarters of persons with disabilities in Lebanon have no access to a bathroom or toilet that is adapted to their needs.156 Lebanese law requires public buildings to be accessible for persons with disabilities. A 2006 study, however, found 95% of public buildings to be inaccessible. Much of the transport infrastructure is similarly inaccessible to persons with disabilities, severely restricting their movement and participation in society.157 In order to gain better insight into children with disabilities’ participation in community life, the fourth set of indicators assesses the % of people who think children with physical disabilities should participate in the life of their community and % of people who think children with intellectual disabilities should participate in the life of their community. Participation in community life Children with disabilities ‘are at high risk of experiencing violence, both within the home and in the wider community. […] [Physical] violence may be common between family members, and used as a 152

UNRWA 2016.

153

Government of Lebanon and United Nations 2017: 81, 109-110.

154

Ibid: 118. Women’s Refugee Commission 2013: 7. 156 Government of Lebanon and United Nations 2017: 160. 157 Article 19 2015: 13. 155

217 way of managing behaviours that are perceived as negative’.158 The relatively low rates of disabilities reported for Lebanese, Syrian, and Palestine refugee domains (see further down) may point to tendencies to bar children with disabilities from taking part in community life. One signifier of social exclusion is that only 37.7% of Lebanese persons with disabilities were found to be married in a 2004 survey, compared to 53.3% of the general population.159 Residential institutions The fifth indicator assessed under Disabilities examines the % of people who find it acceptable if families of children with physical and intellectual disabilities place them in residential institution. MOSA subsidizes a number of residential institutions where Lebanese children with disabilities can live. An estimated 2% of Lebanese children live in residential institutions – one of the highest rates in the world.160 One disability rights expert told Human Rights Watch that, ‘These are really institutions, not schools. They aren’t focused on education’.161 Unjustified placement in residential institutions is also reported as a way to gain access to education, healthcare and other basic services.162 ‘Parents of children with disabilities often have no educational alternatives for their children, even though the education in these institutions is of significantly lower quality than that in regular schools, with many children not even completing primary school’.163 Subsidised residential institutions are not accessible to non-Lebanese children, who rely on nonsubsidised institutions or who have to stay home.

9.2. Qualitative findings overview 9.2.1. Supply and demand of services The disabilities indicators for the KAP Study are related to attitudes on the inclusion of children with physical and intellectual disabilities into education, community, social and work life. Data indicate that although there is a growing demand for services in the field of disabilities, supply still falls short.

MOSA/SDCs In May 2000, the Lebanese Parliament approved Law No. 220, which secures the basic rights for persons with disabilities including comprehensive livelihood services such as social services, education, health and employment. However, the implementation of the legislation remains work in progress. Lebanese citizens are able to benefit from certain services by obtaining a disability card, which is issued by 8 (out of 228) SDCs in all of Lebanon, one in each mohafaza.164 The card is valid for two and a maximum of five years, after which it needs to be renewed. Cases of intellectual disability are diagnosed and categorised at the MOSA HQ in Beirut through an IQ test that can only be taken from the age of 5 years onwards, which disregards the fact that negative effects of disabilities often can be prevented at an earlier age. 158

Women’s Refugee Commission 2013: 7. 2004 Central Administration of Statistics’ household living conditions survey, quoted in Article 19 2015: 13. 160 Ibid: 14. 161 Human Rights Watch 2016. 162 Government of Lebanon and United Nations 2017: 121. 163 Article 19 2015: 14. 164 In August 2017, the Lebanese parliament declared the establishment of the new mohafaza of KeserwanJbeil, bringing the total of mohafaza to nine. 159

218 Often, MOSA/SDCs have difficulties referring children with disabilities because they themselves do not have adequate information about available services. MOSA/SDCs lack the specialised staff to adequately deal with disabilities and are rarely designed for people with disabilities, e.g. by not being wheelchair-friendly. Currently, there exists an institutional separation between social services and disabilities; the latter is not mainstreamed in programmes. The demand for services for children and adults with disabilities is increasing every year, but the current availability of services cannot cope with the existing demand.

UNRWA UNRWA started working on disabilities in the 1970s, however, the services have so far remained relatively limited. A disability policy has recently been adapted to reflect a twin-track approach, in which disability is mainstreamed into all UNRWA programmes, as well as in the work with Palestine refugee communities ‘on the ground’. The identification of disabilities follows a similar procedure as that at MOSA, whereby a clinic psychologist conducts a test and diagnoses the child or adult person. Persons with disabilities can receive an identification from the Palestinian Disability Forum (PDF). Critically, UNRWA does not provide services for individuals with disabilities specifically; however, disability represents one of many criteria for being prioritised to entering UNRWA’s Social Safety Net programme, which provides poor families with $10 per family member every month in financial support. At the time of writing, there are over 7,000 persons with disabilities registered with PDF, while there are 6,850 persons with disabilities registered with UNRWA in the Social Safety Net programme. Crucially, disabilities can lead to increased vulnerabilities such as debt: more than 90% of Palestine refugees with disabilities registered with UNRWA live under the poverty line. If Palestine refugees want to make use of services provided by the Lebanese state, they need to pay for them.

NGOs Both MOSA and UNRWA work closely together with partners who provide direct services to beneficiaries. At the time of writing, MOSA has contracts with 103 local NGOs and pays a daily fee for each child, while UNRWA has 17 Palestinian partners under the umbrella of the PDF and 7 Lebanese contracted institutions for specialised services. The services available to children with disabilities are generally limited, and are even more limited in Lebanon’s peripheral areas. For instance, some local partners of MOSA only have a capacity to accommodate 10-20 children at a time. MOSA contracts residential institutions for children with disabilities, however, at most of them caregivers pick up children at the end of the day or for the weekends. Across Lebanon, 30 contracted partners are considered residential institutions, one of which has a total of 30 cases with children living continuously in the residential institution. While many Lebanese and Palestine refugees are in great need for support but cannot receive it due to a lack of capacity or funding shortages, Syrians are especially vulnerable as they receive limited support for disabilities and chronic diseases. Syrian respondents in FGDs were often very unsure where or from whom to seek support. Palestine refugees receive support mostly from PDF, a local network that involves Palestinian organisations and groups working with disability among Palestine refugees in Lebanon. It plays an important role in coordinating the work of its 17 member organisations and in advocating for rights of Palestine refugees with disabilities. Service providers argue that the most effective approach is to work with disabilities in a holistic manner by providing the needed services to the concerned individuals, supporting the family of persons with disability, and promoting the inclusion of the child or adult with disabilities into social, educational and work life. While the demand for services increases year by year, services remain costly and approaches that would provide a longer-term positive impact requires sustained funding, which is often not available given donor-funding schemes.

219


Mount Lebanon

Akkar

North

Bekaa

BaalbekHermel

South

Nabatieh

Lebanese mothers

Palestine refugee fathers

Syrian mothers (IS)

Lebanese girls

Syrian girls

Syrian boys


Lebanese fathers

Table 9.5: Disabilities FGDs matrix The FGDs with caregivers and children covered a number of topics related to children with disabilities, including education, inclusion into society and work opportunities, generating a wealth of data that was further supplemented by KIIs. Overall, all respondents differentiate between physical and intellectual disabilities when it comes to including or interacting with children with disabilities. Children were more open and positive to interacting with children with disabilities, while adults had more concerns about their children’s exposure to children with disabilities. Those concerns were largely related to the physical safety of children without disabilities. It is worth noting that some respondents in FGDs confused mental illness with disability and were subsequently corrected by others in the group. Opinions regarding children with disabilities attending regular pre-schools and schools were divided along three main lines. The most inclusive argument was made by a number of female Palestine refugee respondents, who have children with disabilities themselves. Their ideal scenario is for all children to attend the same class with the support of a shadow teacher. A number of Palestine and Syrian refugee respondents preferred for children with disabilities to attend separate classes but remain in regular schools. This would allow children to play together and socialise during break time. The majority of Lebanese and a number of Palestine and Syrian refugee respondents preferred that children with disabilities attend separate specialised schools. Respondents were moderately more accepting of children with physical disabilities to attend regular school than for children with intellectual disabilities. “The presence of a child with disabilities in a regular school will affect him and make him feel different, from the point of view of being socially included and having friends” Lebanese woman, FGD in Beirut, May 2017 The main arguments provided for placing children with disabilities in separate educational institutions centred around the quality of education and the benefits for children themselves. Respondents mentioned that teachers would be overburdened if in addition to dealing with a full classroom, they had to ensure children with disabilities follow the curriculum. Shadow teachers for cases of disability that are not severe were mentioned by some respondents as a solution. The majority of respondents stated that specialised schools would benefit children with disabilities since they would benefit from a tailored curriculum and get the care they need. In regular schools, other children would most likely bully them and might inflict harm on them. However, it was also mentioned that some children with disabilities might be violent and injure others, and therefore needed to be kept separate. Those respondents who stated having close relatives, children or acquaintances with disabilities showed a higher level of acceptance of their social inclusion. Palestine refugee caregivers seemed to have the most exposure to children with disabilities in their daily lives, while Lebanese had the least. Those respondents most sceptical about intermingling, including Lebanese, were afraid that their children would be hurt or copy behaviour of children with disabilities. While all respondents were somewhat accepting of marriage to individuals with physical disabilities, Syrian respondents in ISs were also accepting of marriage to individuals with intellectual disabilities as long as they did not display

220 violent behaviour. A few Palestine refugee female and male respondents mentioned thinking about emigrating to Europe, because there, services for people with disabilities maintain a higher quality than those in Lebanon. “Individuals with disabilities are treated well in Europe but are marginalised in all the Arab countries.” Palestine refugee man, FGD in Mount Lebanon, May 2017 Children expressed more positive attitudes towards inclusion of children with disabilities than caregivers. All children respondents were open to the idea of having children with physical disabilities join their classrooms, and mentioned that children with intellectual disabilities could do so if they had special assistance; only severe cases would require special classes. Children also expressed high levels of empathy towards children with disabilities, saying that they would be happy to interact with them. “We would benefit from mixing with children with disabilities in regular school and they might improve by mingling with ordinary children.” Lebanese girls, FGD in North, May 2017 In theory, caregivers expressed positive attitudes towards individuals with physical disabilities working, however, less so towards individuals with intellectual disabilities. The criterion for including persons with disabilities in work was that they should be able to complete tasks required in a job. The possibility of working therefore was taken to depend on the level of disability. In some cases, it was mentioned that having an individual with disabilities working in a restaurant or shop could cause embarrassment and should be avoided. Additionally, the majority of caretaking burden is placed on the mother, who needs to be proactive in seeking support for the child and inclusion from the community. While Palestine refugee respondents mentioned reaching out to UNRWA for available services, Lebanese and Syrians respondents had limited knowledge on available support services from MOSA and aid agencies.

9.3. Baseline indicators: Disabilities 9.3.1. All domains

EDUCATION % of respondents who believe children with physical disabilities should go to regular preschools and schools. % of respondents who believe children with intellectual

Lebanese residents




Male

55%

45%

57%

41%

Female

55%

46%

48%

61%

Total

55%

45%

49%

52%

Male

16%

16%

11%

21%

Female

19%

18%

10%

25%

Totals

53%

221 disabilities should go to regular preschools and schools. WORK % of respondents believe that young people with physical disabilities should work % of respondents believe that young people with intellectual disabilities should work SOCIAL LIFE % of respondents who believe children with physical disabilities should be integrated into society % of respondents who believe children with intellectual disabilities should be integrated into society COMMUNITY LIFE % of respondents who believe that children with physical disabilities should participate in community life % respondents who believe that children with intellectual disabilities should participate in community life

Total

18%

17%

11%

23%

Male

70%

35%

39%

49%

Female

65%

31%

32%

60%

Total

67%

33%

33%

55%

Male

20%

10%

7%

12%

Female

22%

9%

5%

13%

Total

21%

9%

6%

12%

Male

73%

59%

52%

40%

Female

69%

53%

47%

51%

Total

70%

56%

48%

46%

Male

22%

31%

27%

20%

Female

27%

36%

14%

19%

Total

25%

34%

16%

20%

Male

70%

55%

54%

51%

Female

66%

50%

50%

62%

Total

68%

53%

51%

58%

Male

23%

33%

27%

37%

Female

27%

38%

14%

37%

Total

25%

31%

16%

37%

61%

60%

57%

69%

59%

56%

46%

63%

RESIDENTIAL INSTITUTIONS % of respondents Male who find it acceptable if families of children with Female physical disabilities

18%

59%

18%

66%

26%

64%

27%

222 place them in residential institutions % of respondents who find it acceptable if families of children with intellectual disabilities place them in residential institutions

Total

60%

58%

48%

66%

Male

61%

72%

72%

73%

Female

62%

66%

77%

74%

Total

61%

70%

76%

73%

60%

64%

Table 9.6: Overview of disabilities indicators results by domain, gender and in total Main findings from the quantitative survey for all domains Across all questions and domains respondents were more favourable to the inclusion of children with physical disabilities than children with intellectual disabilities, with the exception of placement of children with disabilities in institutions. Overall, Lebanese respondents were more favourable towards the inclusion of children with physical disabilities than other domains. Education More than half of all the respondents said that children with physical disabilities should go to regular school or preschool. Less than one in five persons thought that children with intellectual disabilities should go to regular school. Lebanese and Palestine refugee respondents were more favourable to inclusion than Syrians.

55%

53%

52% 45%

49%

23% 18%

18%

17% 11%

Lebanese

Registered Syrians

Syrians living in ISs Physical

Palestine refugees

Total

Intellectual

Table 9.7: Respondents who believe children with physical disabilities should go to regular preschools and schools by domain and in total Work

223 3 out of 5 respondents thought that young people with physical disabilities should work, compared to only 1 out of 5 for intellectual disabilities. Lebanese respondents were the most favourable and Syrian respondents the least favourable for both physical and intellectual disabilities.

67% 59%

55% 33%

33%

21% 9%

Lebanese

Registered Syrians

6% Syrians living in ISs Physical

18%

12%

Palestine refugees

Total

Intellectual

Table 9.8: Respondents who believe that young people with disabilities should work by domain and in total Social Inclusion While 2 out of every 3 respondents think that children with physical disabilities should be integrated into society, only 1 in 4 thinks that children with intellectual disabilities should be integrated into society. For physical disabilities, Lebanese were the most favourable to inclusion overall, while Syrians registered with UNHCR had the most favourable attitudes on intellectual disabilities.

70%

66% 56% 48%

46%

34% 26%

25% 16%

Lebanese

Registered Syrians

Syrians living in ISs physical

20%

Palestine refugees

Total

Intellectual

Table 9.9: Respondents who believe children with disabilities should be integrated into society by domain and in total Inclusion in community life The attitudes towards inclusion of children with disabilities in community life largely mirror attitudes towards the integration into society. The only exception is in the responses of Palestine refugees where a higher proportion of respondents is in favour of community participation than of integration into society.

224

68% 53%

51% 37%

31%

25%

64%

58%

27% 16%

Lebanese

Registered Syrians


Palestine refugees

Total

Intellectual

Table 9.10: Respondents who believe that children with disabilities should participate in community life by domain and in total Residential institutions 3 out of 5 respondents thought it was acceptable to place children with disabilities in residential institutions. Interestingly, among the Lebanese, there is no big difference between physical and intellectual disabilities. 76%

70% 60% 61%

73% 66%

58%

60%

64%

48%

Lebanese

Registered Syrians


Palestine refugees

Total

Intellectual

Table 9.11: Respondents who find it acceptable if families of children with disabilities place them in residential institutions by domain and in total

9.3.2. Lebanese domain Integration into education Physical disabilities 55% of Lebanese respondents believe that children with physical disabilities should attend regular preschool or school. In the North, Bekaa and Beirut, responses were divided more or less equally between those who believe and those who do not believe that children with physical disabilities should attend regular preschool and school. The most positive attitudes were found in Nabatieh, Mount Lebanon and the South, whereas Baalbek-Hermel and Akkar exhibited the most negative attitudes.

225

36%

South

50% 50%

North 40%


60%

23%

77% 46%

Bekaa

54%

51% 49%


64%

75%

25%

Akkar

35%

No

65%

Yes

Table 9.12: Lebanese respondents who believe that children with physical disabilities should go to regular school or preschool with other children by mohafaza Respondents’ belief that children with physical disabilities should attend regular preschool or school was underpinned by a number reasons. The most common reason at 64% was that specialised schools are more beneficial for children with disabilities as they can offer a tailored curriculum. The secondmost cited reason at 45% was that teachers in regular schools are not able to work with children with disabilities, followed, at 40%, by conditions in ‘normal’ schools not being adapted for children with disabilities. Other reasons given had to do with the perceived wellbeing of children with disabilities and the potential danger children with disabilities present to other children.

226

Society is not ready to accept them

5%

They may be dangerous for others

9% Is not able to follow a normal curricula

18%

To communicate with similar children and not feel isolated

25% 33%

To avoid the bad attitudes of other students

27%

To avoid a negative affect on other children

40%

Conditions are not adapted for them in normal schools

45% 64%

A regular teacher is not able to work with them Special school provides special education and approach

Table 9.13: Reasons cited by Lebanese respondents who believe that children with physical disabilities should not go to regular school or preschool with other children Intellectual disabilities A total of 18% of Lebanese respondents believe that children with intellectual disabilities should attend regular preschool or school with other children. The numbers are similar among male and female respondents, with women slightly more positive towards children with intellectual disabilities attending regular education facilities at 19%, compared to 16% for men. Over 80% of Lebanese male and female respondents do not believe that children with intellectual disabilities should attend regular education facilities. Slight variations are exhibited by mohafaza, with Nabatieh and Beirut displaying the most positive attitudes and Bekaa and Baalbak-Hermel displaying the least positive attitudes.

South

85%

15%

North

81%

19%

Mount Lebanon

85%

15%

El Nabatieh Bekaa

40%

93%

7%


60%

35%

65% 92%

8% 85%

15%

No

Yes

227 Table 9.14: Lebanese respondents who believe that children with intellectual disabilities should go to regular school and preschool with other children by mohafaza Around 60% of Lebanese respondents who do not believe that children with intellectual disabilities should attend regular preschools and schools cite the benefits of a specialised school and curriculum as a reason. 30% of respondents believe that they would lower the education level in the class and that conditions are not adapted for them in ‘normal’ schools. Almost 20% believe that the presence of children with intellectual disabilities in regular school may be dangerous for other children. I do not want my children to be in the same class as them Society is not ready to accept them

2% 6%


17%

Is not able to follow a normal curricula

21% 18% 26% 25% 30% 34% 59% 30%

To communicate with similar children and not feel isolated To avoid the bad attitudes of other students To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach They would lower the education level in class

Table 9.15: Reasons cited by Lebanese respondents who believe that children with intellectual disabilities should not go to regular school and preschool with other children

Integration into work life Physical disabilities Overall, 67% of Lebanese total respondents believe that young people with physical disabilities should work. Male respondents are slightly more positive than female respondents, at 70% compared to 65%. Overwhelmingly positive responses were exhibited in Nabatieh, Mount Lebanon, Beirut and the South. The most negative responses were displayed in Baalbak-Hermel and Akkar, consistent with the general trend. Most Lebanese respondents from FGDs were positive about individuals with physical disabilities working as it boosted their moral and made use of their skills. “People with physical disabilities have talent and abilities that are more developed than ordinary people”. Lebanese female caregiver, FGD in Beirut, May 2017 They believed that individuals with physical disabilities should work regular jobs but acknowledged that their job opportunities might be limited due to reduced mobility and access. While Lebanese respondents in Beirut argued for the need to promote employment for persons with disabilities in the FGDs, they suggested individuals with disabilities work from home or from specialised centres on artisanal and handicraft work. In other words, while the right to work is acknowledged, inclusion of persons with disabilities into the regular workforce is not preferred.

228

South North

3%

24%

% 46%

Mount Lebanon

2%

El Nabatieh

1%

54%

19%

80%

11%

Bekaa

5%

Beirut

5%

88% 41%

54%

15%

80%

6%


74%

75%

19%

1%

58%

41%

DK

No

Yes

Table 9.16: Lebanese respondents who believe young people with physical disabilities should work by mohafaza Intellectual disabilities 21% of Lebanese respondents believe that young people with intellectual disabilities should work, in contrast to 75% who believe they should not. The biggest proportion of positive responses is found in Nabatieh and Beirut, at 45% and 30% respectively. The majority of Lebanese respondents however does not believe that young people with intellectual disabilities should work, reaching 92% in the North, 90% in Akkar and 88% in Baalbek-Hermel. Lebanese respondents from FGDs believe that individuals with intellectual disabilities should be able to work basic or simple jobs. Some did not believe they should work as they may not be able to comprehend workplace conditions, not be productive for the business or customers and cause embarrassment. 4%

South North

1%

Bekaa Beirut Baalbek-El Hermel Akkar

92%

7% 6%


75%

21%

68%

26% 1% 45%

53%

3%

87%

10% 5%

65%

30% 4%

88%

9%

90%

10%

DK

No

Yes

229 Table 9.17: Lebanese respondents who believe young people with intellectual disabilities should work by mohafaza Integration into society Physical disabilities 71% of Lebanese respondents believe that children with physical disabilities should be fully integrated into society. An average of 24% believes that they should not be fully integrated into society, and 5% do not have an opinion on the issue. The most positive responses were exhibited in Mount Lebanon at 84%, Nabatieh at 81% and Beirut at 73%. In Baalbek-Hermel, a third of respondents were unsure of the answer, highlighting a knowledge gap. “Many children with disabilities do not go out, they stay at home because of society and their mood.” Lebanese male caregiver, FGD in Nabatieh, June 2017

South North Mount Lebanon El Nabatieh

3% 5% 2% 4%

35%

60% 84%

15%

81%

11% 3%


66%

15%

Bekaa Beirut

31%

34%

55%

25%

73%

29% 5%

37% 34% 34%

DK

No

61%

Yes

Table 9.18: Lebanese respondents who believe children with physical disabilities be fully integrated in society by mohafaza Intellectual disabilities 25% of the total Lebanese respondents believed that children with intellectual disabilities should be fully integrated in society. The majority of respondents at 40% was not sure about their opinion, stating “do not know” as response, while 35% of respondents believed that children with intellectual disabilities should not be fully integrated in society. Responses varied across mohafazat. The most positive attitudes towards children with intellectual disabilities being fully integrated into society were found in Nabatieh at 40% and Beirut at 32%. The most negative attitudes towards children with intellectual disabilities being fully integrated into society were noted in the South at 55%, in Akkar and in the North at 36% respectively. The high levels of uncertainty among some respondents indicates that they have not made up their minds on the

230 issue: in the Bekaa and Baalbek-Hermel, around 60% of Lebanese respondents are undecided whether children with intellectual disabilities should be fully integrated into society.

South

24%

55%

21%

North

36%

24%

Mount Lebanon

26%

El Nabatieh

26%

Bekaa

37% 38% 34% 40% 62%

19% 19%


40%

39%

30% 32%

60%

21% 19%

Akkar

24%

DK

No

36%

40%

Yes

Table 9.19: Lebanese respondents who believe children with intellectual disabilities be fully integrated in society by mohafaza

Participation in community life Physical disabilities 68% of Lebanese respondents believe that children with physical disabilities should participate in community life, in contrast to 26% who do not believe that and 5% who are undecided. The most positive responses for children with physical disabilities to participate in community life were noted in Mount Lebanon at 82% and in Nabatieh at 80%. In contrast, the most negative responses were noted in Akkar at 45% and in the North at 42%. In Baalbek-Hermel, a third of respondents was undecided about the question at hand.

231


2%

29%

5%

42%

2% 5%

82%

16% 9%

3%


54%

16%

Bekaa Beirut

68%

80% 34%

56%

35%

62%

34% 31% 35% 6%

45% 49%

DK

No

Yes

Table 9.20: Lebanese respondents who believe children with physical disabilities should participate in community activities by mohafaza Intellectual disabilities 25% of Lebanese respondents believe that children with intellectual disabilities should participate in community life. In contrast, 35% of the total respondents state that they should not participate in community life, while 40% of the total respondents are undecided. The high levels of indecisiveness indicate a lack of knowledge and awareness on the issue at hand. The highest levels of indecisiveness were noted in the Bekaa at 56% and Baalbak-Hermel at 55%. “Children with disabilities are entitled to play with other children, join social occasions, join in outings and be invited to play with other children in their homes.” Lebanese male caregivers, FGD in Nabatieh, June 2017 The fewest responses in favour of children with intellectual disabilities participating in community life were noted in the North and Akkar, while the most responses in favour were exhibited in Nabatieh and Mount Lebanon. Lebanese respondents in FGDs explained that children with disabilities should be fully included in the social life of the community except if they could be a source of danger and harm to others.

232

23%

South North

48%

36%

16%

Mount Lebanon

33% 29%

El Nabatieh

38% 38% 38%

25%

Bekaa

56%

23% 21%

Beirut

27%


51%

26%

20%

42% 31% 55%

25% 34%

17%

DK

No

49%

Yes

Table 9.21: Lebanese respondents who believe children with intellectual disabilities should participate in community activities by mohafaza Residential institutions Physical disabilities Overall, 60% of Lebanese respondents believed it was acceptable to place children with physical disabilities in residential institutions. While 31% of total respondents did not believe that it was acceptable to do so, 9% were undecided. In the various mohafazat, respondents who found it acceptable to place children with physical disabilities in residential institutions ranged from 43% in the Bekaa to 81% in Nabatieh. Respondents who did not find it acceptable to place children with physical disabilities in residential institutions ranged from 12% in Nabatieh to 47% in Beirut. Almost 20% of respondents in the Bekaa and Baalbek-Hermel were undecided.

233

7%

South North

6%

Mount Lebanon

7%

64%

12%

81% 39% 43%

6%


60%

27%

19%

Bekaa

47% 47% 19%

6%

56%

34%

9%

El Nabatieh

Beirut

37%

26%

55% 32%

DK

61%

No

Yes

Table 9.22: Lebanese respondents who believe it is acceptable to place children with physical disabilities in residential institutions by mohafaza Intellectual disabilities 71% of Lebanese respondents found it acceptable to place children with intellectual disabilities in residential institutions. While 23% did not find it acceptable, around 15.5% was undecided on the issue. Opinions differed across mohafazat. The most respondents who did not find it acceptable to place children with intellectual disabilities in residential institutions were in the South at 37% and the North and Akkar at 30%. A significant proportion of respondents was undecided, especially in Nabatieh and Bekaa at 33% and 30% respectively. “In Lebanon, people need a lot of time to understand disability, which is why I would prefer to place children with disabilities in a private institution, in order for them not to be mocked by others.” Lebanese male caregivers, FGD in Nabatieh, June 2017 Respondents from the FGDs stated that they had more trust in private sector institutions rather than in public services, since they were argued to be better equipped and staffed. Overall, knowledge of centres and their life was limited, with respondents not sure how to access services for children with disabilities.

234

12%

South North

9%

Mount Lebanon

14%

Akkar

63% 33% 52% 30%

8%

62%

11%

Baalbek-El Hermel

61%

23%

15%

Beirut

51%

30%

El Nabatieh Bekaa

37%

12%

20%

69%

20% 68%

8%

29%

DK

No

63%

Yes

Table 9.23: Lebanese respondents who believe it is acceptable to place children with intellectual disabilities in residential institutions by mohafaza

9.3.3. Registered Syrians domain Integration into education Physical disabilities A total of 45% of registered Syrian respondents believed that children with physical disabilities should attend regular preschool and schools. The most positive attitudes were exhibited in the South and in Beirut at 81% and 70% respectively, while the least positive attitudes were exhibited in BaalbekHermel and Bekaa at 85% and 65% respectively.

235

19%

South

81%

North

56%

44% 47%

Mount Lebanon

53%

44%

El Nabatieh Bekaa

56% 65%

35% 30%


70% 85%

15% 46%

Akkar

No

54%

Yes

Table 9.24: Syrian respondents registered with UNHCR who believe that children with physical disabilities should go to regular school or preschool with other children by mohafaza Of those respondents who believed that children with physical disabilities should not attend regular preschool or school, 55% believed that conditions in normal schools were not adapted to accommodate them and 45% believed that specialised schools are more beneficial to children with physical disabilities.

Society is not ready to accept them

2%


8% Is not able to follow a normal curricula

17%

To communicate with similar children and not feel isolated

21% 31%

To avoid the bad attitudes of other students

29% 55% 41% 45%

To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach

Table 9.25: Reasons cited by Syrian respondents registered with UNHCR who believe that children with physical disabilities should not go to regular school or preschool with other children

236 Intellectual disabilities 17% of registered Syrian respondents believe that children with intellectual disabilities should attend regular preschool and school with other children, in contrast to 83% who believe that they should not. Across mohafazat, the majority of responses were not in favour of children with intellectual disabilities attending formal education activities. The most positive attitudes were exhibited in Beirut at 30% and in Akkar at 26%.

South North

80%

20%

89%

11%

Beirut

Akkar

81%

19%

El Nabatieh

Baalbek-El Hermel

77%

23%

Mount Lebanon

Bekaa

86%

14%

70%

30%

92%

8% 74%

26%

No

Yes

Table 9.26: Syrian respondents registered with UNHCR who believe that children with intellectual disabilities should go to regular school or preschool with other children by mohafaza Of those who did not believe that children with intellectual disabilities should attend regular preschool and school, 40-46% believed that specialised school would be a better option for the children in question, regular teachers would not be able to work with them and conditions in regular schools were not adapted to them. 31% of registered Syrian respondents stated that children with intellectual disabilities should be excluded from regular education establishments as they could have a negative effect on other children, and 16% of respondents stated that they may be dangerous for others.

237 I do not want my children to be in the same class as them Society is not ready to accept them

1% 4%


16% 18% 17% 27% 31% 40% 43%

46% 21%

Is not able to follow a normal curricula To communicate with similar children and not feel isolated To avoid the bad attitudes of other students To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach They would lower the education level in class

Table 9.27: Reasons cited by Syrian respondents registered with UNHCR who believe that children with intellectual disabilities should not go to regular school or preschool with other children Integration into work life Physical disabilities 33% of registered Syrian respondents believe that young people with physical disabilities should work. However, most respondents at 64.5% believe that young people with physical disabilities should not work and 3% are undecided. There are clear variations by mohafaza: the most negative attitudes towards young people with physical disabilities working were noted in Baalbek-Hermel and the Bekaa, while the most positive were noted in Beirut, the South and Mount Lebanon.

South North Mount Lebanon El Nabatieh Bekaa

1%

41%

1%

67%

32% 2%

46%

4%

53%

48% 48%

6%

84%

10%


58%

33%

67%

3% 6%

91%

Akkar

59%

41%

DK

No

Yes

238 Table 9.28: Syrian respondents registered with UNHCR who believe that young people with physical disabilities should work by mohafaza Intellectual disabilities 9% of registered Syrian respondents believe that young people with intellectual disabilities should work, compared to 89% who do not believe so. The responses were consistent on a mohafaza level except for Beirut and Mount Lebanon, where attitudes were more positive: in Beirut 30% of respondents believed that young people with intellectual disabilities should work and in Mount Lebanon 21% believed so.

South North Mount Lebanon El Nabatieh Bekaa

2% 1% 3%

Akkar

97%

2%

76%

21% 2%

90%

8% 4% 4%


90%

8%

92% 70%

30% 1% 2%

97% 97%

3% DK

No

Yes

Table 9.29: Syrian respondents registered with UNHCR who believe that young people with intellectual disabilities should work by mohafaza

Integration into society Physical disabilities Overall, 56% of registered Syrian respondents believe that children with physical disabilities should be fully integrated in society. This can be compared to 35% of respondents who believe that they should not be and 9% of respondents who are undecided. Mohafazat in which respondents believe most strongly in fully integrating children with physical disabilities are Mount Lebanon, Nabatieh and Beirut. The most mixed results are found in Baalbek-Hermel and the Bekaa, with many undecided respondents.

239


3% 5%

60%

15%

4%

84%

15%

81%

11% 3%

34%

55%

25%


66%

35%

2%

Bekaa Beirut

31%

73%

29% 5%

37% 34% 34%

DK

61% No

Yes

Table 9.30: Syrian respondents registered with UNHCR who believe children with physical disabilities should be fully integrated in society by mohafaza Intellectual disabilities 33% of registered Syrian respondents believe that children with intellectual disabilities should be fully integrated in society. The rest of respondents are split almost evenly between 31.5% who believe they should not be fully integrated in society and 35% who are undecided. The most positive attitudes are exhibited in the North and in Akkar at 45% and 37% respectively. The significant level of undecided responses highlights a gap in knowledge and represents an opening for shaping people’s attitudes.

South North

8%

47% 45%

Mount Lebanon

29%

Bekaa

37%

45%

24%

Beirut

Akkar

33%

34% 32% 34%

El Nabatieh

Baalbek-El Hermel

38%

30% 32%

31% 50%

20%

30% 65%

19% 17% 15% 37% DK

No

48%

Yes

Table 9.31: Syrian respondents registered with UNHCR who believe children with intellectual disabilities should be fully integrated in society by mohafaza

240 Participation into community life Physical disabilities 53% of registered Syrian respondents believe that children with physical disabilities should participate in community life, while 39% believe that they should not. On a mohafaza level, the respondents who exhibited the most positive attitudes were in Beirut and Nabatieh at 80%, Mount Lebanon at 75% and the South at 66%. The most negative attitudes to children with physical disabilities participating in community life were noted in the North and in Akkar at 77% and 70% respectively.

South

1%

33%

North Mount Lebanon

77%

23% 5% 6%

El Nabatieh

20%

75%

14%

80%

8%

Bekaa Beirut

36%

56%

20%


66%

80% 27%

39% 34%

2%

70%

28% DK

No

Yes

Table 9.32: Syrian respondents registered with UNHCR who believe children with physical disabilities should participate in community life by mohafaza Intellectual disabilities 31% of registered Syrian respondents in Mount Lebanon believe that children with intellectual disabilities should participate in community life. In contrast, 40% of respondent in the same mohafaza believe that they should not and 29% are undecided. The most positive attitudes were expressed in Bekaa at 45%. Half of respondents in Beirut and Baalbek-Hermel were undecided on this issue, while the most negative attitudes were articulated in the North and Akkar at 73%.

241

37%

South North

21% 9%

73%

18%

Mount Lebanon

31% 29% 30%

El Nabatieh

40%

36% 34%

29% 26%

Bekaa Beirut

45% 50%

20%


42%

30% 51%

25% 23% 16%

73%

11% DK

No

Yes

Table 9.33: Syrian respondents registered with UNHCR who believe children with intellectual disabilities should participate in community life by mohafaza

Residential institutions Physical disabilities Out of the total of registered Syrian respondents, 58% found it acceptable to place children with physical disabilities in residential institutions. The highest proportion of registered Syrian respondents replying to find it acceptable were in Nabatieh at 78% and the lowest in Beirut at 43%. The highest proportion of respondents who did not find it acceptable was in Akkar, the North and Bekaa.

242

7%

South

37%

6%

North

34%

9%

Mount Lebanon

7%

El Nabatieh

60%

27%

64%

12%

81% 19%

Bekaa

39% 43%

6%

Beirut

47% 47% 19%

Baalbek-El Hermel

26%

6%

Akkar

56%

55% 32%

DK

61% No

Yes

Table 9.34: Registered Syrian respondents with UNHCR who find it acceptable to place children with physical disabilities in residential institutions by mohafaza

Intellectual disabilities 69% of registered Syrian respondents find it acceptable to place children with intellectual disabilities in residential institutions. While 21% of respondents do not find it acceptable, 10% are undecided. Responses of those who believe that it is acceptable to place children with intellectual disabilities in residential institutions range between 100% in Beirut to 46% in the South, while those who do not find it acceptable are mostly in the North at 48% and in Akkar at 41%.

22%

South North

46%

1%

Mount Lebanon

48% 51% 7%

18%

10%

El Nabatieh Bekaa

32%

4%

75% 28%

62%

21% 74%


100% 4% 5% 2%

91% 41% DK

No

57% Yes

243 Table 9.35: Syrian respondents registered with UNHCR who find it acceptable to place children with intellectual disabilities in residential institutions by mohafaza

9.3.4. Syrians in ISs domain Integration into education Physical disabilities 49% of Syrians in ISs believe that children with physical disabilities should attend regular preschool and school. Male respondents have a more positive attitude than female respondents, at 57% versus 48%. Of those who do not believe that children with physical disabilities should attend regular preschool and school, more than half cite that the child would not be able to follow the normal curricula, implying that they would not being able to hear the teacher or read what is written on the board. “Other children would make fun [of the child with disabilities]. The child will feel sad and will stop wanting to go to school.” Syrian female caregiver, FGD in an IS in Akkar, June 2017

1% 3% 17% 15% 18% 24% 31% 34% 62%

Society is not ready to accept them They may be dangerous for others Is not able to follow a normal curricula To communicate with similar children and not feel isolated To avoid the bad attitudes of other students To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach

Table 9.36: Syrian respondents in ISs who believe that children with physical disabilities should not attend regular school or preschool Intellectual disabilities Only 11% of Syrian respondents in ISs believe that children with intellectual disabilities should attend regular preschool and school. Of those 89% who do not believe that they should, 54% state that specialised education establishments would provide a more tailored curriculum, therefore implying that regular schools are not adapted to include children with intellectual disabilities. In a FGD with Syrian female caregivers in an IS in Akkar, most were generally in favour of specialised schools but explained that they were not available for them in Lebanon. Fear of bullying towards the child with disability was high and school administrations were also said to often not accept children with disabilities.

244

1% 11%

12% 9% 13% 18% 35% 34% 54% 18%

Society is not ready to accept them They may be dangerous for others Is not able to follow a normal curricula To communicate with similar children and not feel isolated To avoid the bad attitudes of other students To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach They would lower the education level in class

Table 9.37: Syrian respondents in ISs who believe that children with intellectual disabilities should not attend regular school or preschool Integration into work life Physical disabilities 35% of Syrian respondents in ISs believe that young people with physical disabilities should work compared to 60% who believe that they should not. Men have a slightly more positive attitude to this question.

3% Female

66% 31%

2% Male

63% 35% DK

No

Yes

Table 9.38: Syrian respondents in ISs who believe young people with physical disabilities should work Intellectual disabilities Only 6% of Syrian respondents in ISs believe that young people with intellectual disabilities should work compared to an overwhelming 90% who believe that they should not. Slightly more male respondents, at 7%, than female respondents are undecided about this question.

245

1% Female

94% 5%

7% Male

86% 7% DK

No

Yes

Table 9.39: Syrian respondents in ISs who believe young people with intellectual disabilities should work Integration into society Physical disabilities 49% of Syrian respondents in ISs believe that children with physical disabilities should be fully integrated in society. Interestingly, more female respondents were against integrating children with physical disabilities into society than male, at almost 40% compared to 25%. However, more male respondents were unclear about their opinion than female respondents.

14% Female

38% 47%

Male

23% 25% 52%

DK

No

Yes

Table 9.40: Syrian respondents in ISs who think children with physical disabilities should be fully integrated in society Intellectual disabilities A total of 20% of Syrian respondents in ISs believe that children with intellectual disabilities should be fully integrated in society. Interestingly, men have more positive attitudes towards the social integration of children with intellectual disabilities than women. It is worth noting that 61% of all respondents are undecided about this issue, highlighting the need to provide awareness and knowledge.

246

61% Female

24% 14%

61% Male

11% 27% DK

No

Yes

Table 9.41: Syrian respondents in ISs who think children with intellectual disabilities should be fully integrated in society Participation into community life Physical disabilities 52% of Syrian respondents in ISs believe that children with physical disabilities should participate in community life. While 10% more female than male respondents believe that children with physical disabilities should participate in community life, more male respondents are undecided on this question.

14% Female

35% 50%

20% Male

25% 55% DK

No

Yes

Table 9.42: Syrian respondents in ISs who believe children with physical disabilities should participate in community life Intellectual disabilities 20% of Syrian respondents in ISs believe that children with intellectual disabilities should participate in community life. This percentage is less than half of what respondents replied when asked the same question on physical disabilities. Double of female than male respondents, at 30% compared to 14%, believed that children with intellectual disabilities should not participate in community life. Crucially, over half of total respondents were undecided on this question.

247

56% Female

30% 14%

59% Male

14% 27% DK

No

Yes

Table 9.43: Syrian respondents in ISs who believe children with intellectual disabilities should participate in community life Residential institutions Physical disabilities 51% of Syrian respondents in ISs believe that it is acceptable to place children with physical disabilities in residential institutions. The level of acceptance is higher for male than for female respondents, at 57% compared to 46%, while 20% of total respondents remain undecided on this question.

20% Female

34% 46%

Male

20% 23% 57% DK

No

Yes

Table 9.44: Syrian respondents in ISs who believe it is acceptable to place children with physical disabilities in residential institutions Intellectual disabilities An overwhelming 75% of Syrian respondents in ISs believe that it is acceptable to place children with intellectual disabilities in residential institutions. The rest of respondents are divided between not finding it acceptable, at 11%, and being undecided about this question, at 13.5%.

248

11% Female

11% 77%

16% Male

11% 73% DK

No

Yes

Table 9.45: Syrian respondents in ISs who believe it is acceptable to place children with intellectual disabilities in residential institutions

9.3.5. Palestine refugees domain Integration into education Physical disabilities A total of 51% of Palestine refugee respondents believe that children with physical disabilities should attend regular preschool and school. Interestingly, 61% of female Palestine refugee respondents believed that the children should do so, compared to 41% of male respondents. Of those who do not believe that children with physical disabilities should attend regular education facilities, 86% stated that specialised schools would provide a more tailored curriculum and learning approach.

4% 3% 11% 11% 19% 23% 54% 64% 86%

Society is not ready to accept them They may be dangerous for others Is not able to follow a normal curricula To communicate with similar children and not feel isolated To avoid the bad attitudes of other students To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach

Table 9.46: Palestine refugee respondents who believe that children with physical disabilities should not attend regular school or preschool Intellectual disabilities Only 23% of Palestine refugee respondents believe that children with intellectual disabilities should attend regular preschool and school with other children. This percentage is around half in comparison

249 to children with physical disabilities. Of those 77% who do not believe that children with intellectual should attend regular education facilities, 61% believe that specialised schools would be more beneficial for these children and 54% believe that they would lower the education level in class.

2% 5% 11% 13% 15% 23% 24% 26% 39% 61% 54%

I do not want my children to be in the same class as them Society is not ready to accept them They may be dangerous for others Is not able to follow a normal curricula To communicate with similar children and not feel isolated To avoid the bad attitudes of other students To avoid a negative affect on other children Conditions are not adapted for them in normal schools A regular teacher is not able to work with them Special school provides special education and approach They would lower the education level in class

Table 9.47: Palestine refugee respondents who believe that children with intellectual disabilities should not attend regular school or preschool Integration into work life Physical disabilities 54% of the total Palestine refugee respondents believe that children with physical disabilities should work. Slightly more women than men believed so, at 60% compared to 49%. Moreover, an average of 8% of respondents were undecided.

7% Female

34% 60%

9% Male

42% 49% DK

No

Yes

Table 9.48: Palestine refugee respondents who believe young people with physical disabilities should work Intellectual disabilities Only 12% of all Palestine refugee respondents believe that young people with intellectual disabilities should work. In contrast, 72.5% do not believe that they should work and 15.5% are undecided. In FGDs, female Palestine refugee caregivers stated that it was very difficult for healthy young people to

250 find work, making it a lot more difficult for young people with intellectual disabilities: while the female respondents in the FGDs believed that individuals with disabilities could work, structural limitations were cited as an important barrier.

13% Female

75% 13%

18% Male

70% 12% DK

No

Yes

Table 9.49: Palestine refugee respondents who believe young people with physical disabilities should work Integration into society Physical disabilities 46% of Palestine refugee respondents believe that children with physical disabilities should be fully integrated into society. Female respondents have a more positive attitude than male respondents, at 52% compared to 40%.

6% Female

42% 52%

7% Male

54% 40% DK

No

Yes

Table 9.50: Palestine refugees who believe that children with physical disabilities should be fully integrated in society

Intellectual disabilities 20% of Palestine refugee respondents believe that children with intellectual disabilities should be fully integrated into society. Male respondents have more negative attitudes towards this issue than female respondents: almost 60% of men do not believe that children with intellectual disabilities should be fully integrated into society, compared to 45% of women. Moreover, more women are undecided about the answer than men. “The shopkeeper around the corner did not want my daughter (with down syndrome) to pass by. I had to speak to him over several times to change his mind and educate him, now he likes my daughter.” Female Palestine refugee caregivers, FGD in South, June 2017

251

35% Female

45% 19%

22% Male

58% 20% DK

No

Yes

Table 9.51: Palestine refugees who believe that children with intellectual disabilities should be fully integrated in society

Participation in community life Physical disabilities 56% of Palestine refugee respondents believe that children with physical disabilities should participate in community life. Slightly more female than male respondents have positive attitudes towards this issue. “The community is destroying children with disabilities, and nobody is helping us [as families who have children with disabilities].” Female Palestine refugee caregiver, FGD in South, June 2017

7% Female

31% 62%

10% Male

39% 51% DK

No

Yes

Table 9.52: Palestine refugees who believe that children with physical disabilities should participate in community life

Intellectual disabilities 37% of Palestine refugee respondents believe that children with intellectual disabilities should participate in community life. Female respondents are more undecided than male respondents, at 35% compared to 20%. This points towards a certain flexibility and potential openness that can be seized to shift attitudes towards inclusion.

252

35% Female

28% 37%

20% Male

42% 37% DK

No

Yes

Table 9.53: Palestine refugees who believe that children with intellectual disabilities should participate in community life

Residential institutions Physical disabilities 66% of Palestine refugee respondents find it acceptable to place children with physical disabilities in residential institutions. Here, 22% of men do not find it acceptable to place children with physical disabilities in residential institutions compared to 32% of women.

4% Female

32% 63%

9% Male

22% 69% DK

No

Yes

Table 9.54: Palestine refugees who find it acceptable to place children with physical disabilities in residential institutions Intellectual disabilities 73.5% of Palestine refugee respondents find it acceptable to place children with intellectual disabilities in residential institutions, approximately 7% more than for children with physical disabilities. Palestine refugee respondents in FGDs mentioned the lack of safety in the camps, for instance in Ein el-Helweh, which is why the children with disabilities often stay indoors. Residential institutions are perceived to provide the necessary care, safety and expertise for children with disabilities.

253

6% Female

20% 74%

9% Male

18% 73% DK

No

Yes

Table 9.55: Palestine refugees who find it acceptable to place children with intellectual disabilities in residential institutions

Bibliography Article 19. 2015. Lebanon: Disability and access to information. https://www.article19.org/resources.php/resource/37983/en/lebanon:-disability-and-access-toinformation. Accessed 1 October 2017. Government of Lebanon and United Nations. 2017. Lebanon Crisis Response Plan 2017-2020. Beirut: Government of Lebanon and United Nations. Human Rights Watch. 2016. Preventing a lost generation: Lebanon. Growing up without an education. Barriers to education for Syrian refugee children in Lebanon. https://www.hrw.org/sites/default/files/report_pdf/lebanon0716_brochure_web.pdf. Accessed 1 October 2017. UNHCR, UNICEF, and WFP. 2016. Vulnerability assessment of Syrian refugees in Lebanon 2016. Beirut: UNHCR, UNICEF and WFP.

UNICEF. 2017. Disabilities. www.unicef.org/disabilities/. Accessed 1 October 2017. UNRWA. 2016. Employment of Palestine refugees in Lebanon. https://www.unrwa.org/sites/default/files/content/resources/employment-palestine-refugeeslebanon.pdf. Accessed 1 October 2017. Women’s Refugee Commission. 2013. Disability inclusion in the Syrian refugee response in Lebanon. New York: Women’s Refugee Commission. World Health Organization. 2017. Disability and health. http://www.who.int/mediacentre/factsheets/fs352/en/. Accessed 1 October 2017.

254

10. C4D Communication for development or C4D is key to UNICEF’s global pursuit of social and behavioural change in support of children’s welfare. ‘C4D involves understanding people, their beliefs and values, the social and cultural norms that shape their lives. It involves engaging communities and listening to adults and children as they identify problems, propose solutions and act upon them. Communication for development is seen as a two-way process for sharing ideas and knowledge using a range of communication tools and approaches that empower individuals and communities to take actions to improve their lives’.165 ‘C4D practitioners believe that sustainable and long–term behavioural and social change is the result of a participatory, human rights-based process of social transformation. This process helps shift political, social and support systems by giving voice to members of all communities and providing them with the skills they need to advocate effectively for long-lasting changes’.166 C4D is only effective when based on evidence. As part of UNICEF Lebanon’s C4D agenda, this chapter contributes evidence on the exposure of traditional and new media across population domains, age, gender, and locality in Lebanon.

10.1. Situation analysis 10.1.1. Preferred traditional media and type of programming A 2013 study by Qatar’s Northwestern University found that 99% of Lebanon’s inhabitants watch TV (for an average of 21 hours per week), 51% listen to the radio (7 hours per week), and 34% read newspapers (3 hours per week).167 UNICEF’s 2016 baseline survey revealed low newspaper exposure and high TV exposure among women aged 15 to 49 years regardless of population domain (see table 10.1). Moreover, it established that 21% of Syrian women, 6-7% of Palestinian women, and 4% of Lebanese women have no exposure to any traditional media. Weekly exposure to all three traditional media (newspapers, radio, TV) was found to depend on education level and mohafaza.168 Another study found that Syrian refugee youth spend around 25% of their leisure time watching television.169

165

UNICEF 2017a.

166

UNICEF 2017b.

167

Northwestern University in Qatar 2013.

168

UNICEF 2016: 337.

169

Abla and Al-Masri 2014.

255

Table 10.1: Exposure to traditional media among women aged 15-49170

10.1.2. Baseline indicators Preferred traditional media (TV, radio, newspapers) across population domains, gender, and mohafazat. Preferred type of programming (news programmes, serials, talk-shows, children programming at what time) across population domains, gender, and mohafazat. Access and use of the internet 75.9% of the population of Lebanon was connected to the Internet in 2016.171 UNICEF’s 2016 baseline survey looked into the use of Internet and social media among women aged between 15 and 24 years, revealing large differences in modern media exposure across population domains (see table 10.2). Internet use is more widespread among women aged between 20 and 24 and also strongly associated with locality and education level.172 Access and use of social media WhatsApp (99%) and Facebook (95%) are the most used social media applications in Lebanon. WhatsApp is the preferred social media channel of 59% of social media users and is accessed by 97% of users on a daily basis. 95% of social media users own a Facebook profile, of whom 83% access Facebook on a daily basis, and 90% do so using a handheld device.173

170

Ibid. Please note that population categories in this figure are not fully aligned with KAP Study population domains. 171

Internet World Stats 2017.

172

UNICEF 2016: 338.

173

TNS 2015.

256

Percentage of women exposed to Internet and social media on a weekly basis 100% 80% 60% 40% 20% 0% Lebanese

Syrian Internet

PRL

PRS

Social media

Table 10.2: Exposure to Internet and social media among women aged 15-49174 Preferred way of communication for services To obtain a detailed and current understanding of how UNICEF can best use communication tools across domains in Lebanon, the last KAP indicator under C4D assesses the preferred way of communication for services.

10.2. Qualitative findings overview 10.2.1. Supply and demand of services The landscape of traditional and new media in Lebanon is varied and consists largely of privately owned media. Television continues to be the most popular traditional medium, while radio and newspapers lag far behind in popularity. The Internet is used mostly for social purposes, in particular to stay in touch with friends and family. Mobile phones are the principal device for accessing the Internet. The two most popular applications are WhatsApp and Facebook. Television penetration is at 92% in Lebanon, which can be compared to 80% smartphone penetration.175 Traditional media tend to be affiliated – or at least, in public perception, associated – with Lebanon’s various political factions and economic interests.176 According to a 2016 audience study by IPSOS and Nielsen, Lebanese TV networks have the following audience shares:

174

LBCi

14.8%

MTV

10.3%

Al-Jadeed

10.2%

Ibid. Please note that population categories in this figure are not fully aligned with KAP Study population domains. 175

IPSOS and Nielsen 2017.

176

Leffler and Yap 2017.

257 OTV

3.0%

Future TV

1.5%

Al-Manar TV

1.2%

Table 10.3: Lebanese TV networks audience shares (2016) These percentages of audience shares add up to a mere 41%. This does not change significantly if networks with even smaller shares of the TV audience are added. This indicates that at least half of the TV audience in Lebanon watches networks other than Lebanese. Internet penetration was 76% in Lebanon in 2016.177 Social media penetration out of Internet users was 96%.178 Smartphone penetration in Lebanon is 80%.179

10.2.2. FGDs summary No specific FGDs were held on the topic of C4D, however, data was gathered by participants in most FGDs across Lebanon.180 Respondents seem to sometimes provide answers that they believe to correspond to what they assume to be an official version. Awareness campaigns appear to thus have had an effect. At the same time, knowledge and attitudes do not necessarily translate into practice. To mention just two examples: (a) parents and caregivers acknowledge the benefits of positive discipline but nevertheless use and condone verbal and physical violence against children; (b) compared to other studies, respondents in the KAP Study seem to exaggerate the number of months that mothers breastfeed and practice exclusive breastfeeding. Another finding is that respondents at times are unaware of who is approaching them and for what purpose. At an FGD with Syrian women in Nabatieh it became clear that some of them had been interviewed by “the UN” about living conditions and nutrition. They complained to the “UN” surveyors about their leaking roof and told the FGD group that they never heard from “the UN” again. Similar knowledge gaps could be observed during data collection for the KAP Study. A few respondents were under the impression that participation in the study would result in immediate rewards, although no rewards were mentioned or promised. Similar anecdotes were told in other FGDs and by KII respondents. A possible conclusion is that beneficiaries not always are able to differentiate between the suppliers of services and therefore grow suspicious and frustrated when services are not delivered.

10.3. Baseline indicators: C4D 10.3.1. All domains Preferred traditional media Of all media, television is by far the most popular at 90% for all domains. 5% of total respondents mentioned not to like traditional media, 2% stated radio newspapers respectively.

177

IPSOS and Nielsen 2017.

178

Ibid.

179

Ibid.

180

See Appendix D.

258 Preferred type of TV programming Serials are the most popular type of TV programming at 49% for all domains, followed by news at 30%. Gender differences are worth highlighting, as more men prefer to watch news at 46% while women prefer to watch serials at 61%. Male respondents

Female respondents

Totals

Serials

32%

61%

49%

News

46%

19%

30%

Documentaries

8%

6%

7%

Children programming

3%

6%

4%

Talk shows

5%

4%

4%

No TV

2%

2%

2%

Table 10.4: Preferred type of TV programming for all domains by gender When asked about when respondents preferred to watch TV during the day, with the option to provide multiple answers, 67% respondents prefer to watch TV in the evening and 40% night. No important gender differences were noted on the answers. Evening

67%

Night

40%

Late afternoon

19%

Early afternoon

14%

Morning

12%

Noon No specific time

11% 2%

Table 10.5: Total respondents’ preferred time of day to watch TV Access and use of the internet 71% of respondents access the Internet daily. The next highest response is at 23% for total respondents who never use the internet. 5% use the internet every few days and 1% once a week. For those who do access the internet, 97% do so usually on their mobile phones. Gender differences in daily access to the internet are worth noting. Syrians in ISs have the least access to the internet on a daily basis. A more detailed breakdown will be provided in the sections by domains.

% of respondents who access the internet daily

Lebanese residents




Male

78%

60%

43%

78%

73%

Female

77%

47%

23%

72%

69%

Total

77%

54%

26%

75%

71%

Total

259 % of respondents who never access the internet

Male

16%

38%

50%

12%

21%

Female

16%

50%

72%

20%

24%

Total

16%

43%

68%

16%

23%

Table 10.6.: Overview of C4D indicator on access and use of the Internet by domain, gender and in total When asked what respondents use the Internet for the most, with the option of multiple choice, respondents across all domains stated to use the Internet mainly for social purposes: 75% use it to stay in touch with family and friends and 72% to access social media. A considerably smaller percentage uses the Internet for seeking information at 19%, receiving news at 15% and for work at 13%. Reflecting levels and types of employment, more Lebanese than any of the other respondents use the Internet for work. None of the Syrians in ISs do so.


7%

11%

15%

75%

42% 3%

11%

12%

Palestinians

3% Syrian registered

9%

27%

65%

91%

16%

15%

68%

74%

16% 15% 14% 19%

Lebanese

71% Work Get news about Lebanon Stay in touch with family and friends

77%

Get news about the region & world Get information Social media

Table 10.7: Responses on use of Internet by total respondents by domain

Access and use of social media Most respondents at 75% access social media on a daily basis. A quarter of registered Syrian respondents never access social media and as many as a third of Syrians in ISs do not. Between 10% and 33% of respondents for each domain state never to access social media. Lebanese residents




Total

Male

79%

64%

60%

81%

76%

Female

76%

61%

46%

74%

74%

260 % of respondents who access the social media daily % of respondents who never access social media

Total

77%

63%

49%

77%

75%

Male

9%

23%

32%

4%

11%

Female

10%

28%

33%

10%

12%

Total

10%

25%

33%

7%

12%

Table 10.8: Overview of C4D indicator on access and use of social media by domain, gender and in total

Syrians in Iss

1% 2%

Lebanese

33%

49%

2% 3% 7% 11%

Palestine refugees

Registered Syrians

15%

1% 2%

2% 3%

A few times a month

9%

77%

25%

63%

9% 10% Once a week

77% Every few days

Never

Daily

Table 10.9: Total respondents’ access to social media (Facebook, Twitter and other apps) by domain Asked about what respondents use social media for the most, with answers options possible, most mention to use social media to stay in touch with family and friends, with Syrians in ISs at 90% and Palestine refugees at 69%. Respondents also use social media to get information about services in general, with registered Syrians stating to do so the most at 56% followed by Lebanese at 47%.

261

2%

7%

Syrians in Iss

1%

Registered Syrians

46%

4% 12%

1%

69%

30% 26%

19% 1%

38%

9%

Palestine refugees

Lebanese

90%

22% 22% 20%

85%

22% 21%

17% 16% 12%

56% 83% 25%

47%

Entertainment Stay in touch with family and friends Get news about the region Get new information on services

Work Get world news Get news about Lebanon

Table 10.10: What total respondents use social media for the most by domain

Preferred way of communication for services Asked about how respondents preferred to be informed about available UNICEF services, 60% stated by mobile phone, through SMS. The second-most preferred option was social media (including WhatsApp) at 41% Almost a third, however, prefer to receive this information in person through outreach volunteers. Around 30% preferred to be contacted in person by an outreach volunteer. Qualitative data validates the quantitative findings, as most FGDs preferred to be contacted by mobile phone yet a consistent minority preferred in-person communication.

SMS/Mobile phone

60%

Social Media (incl. WhatsApp)

41%

In person through outreach volunteer

29%

Website on the Internet

13%

Through posters Direct connection

5% 3%

Television

2%

Through radio

1%

Table 10.11: Total respondents preferred way to receive information about available UNICEF services

262

10.3.2. Lebanese domain Preferred traditional media Television is by far the most popular traditional media in the Lebanese domain at 90%. As in the other domains, there is a minority that says that they do not like traditional media. Even fewer prefer newspapers, at just 3%, and the radio, at 2%, as traditional media. Preferred type of programming 62% of female respondents in the Lebanese domain prefer serials as a type of TV programming, while male respondents prefer news at 46%, although almost a third of them also mentioned serials as a preferred type of TV programming. Documentaries come in distant third place at 7% and 10% respectively.

1% Female

1% 1%

7% 4% 5%

62%

19% 1% Male

2% 1% 1% 1%

10% 5%

Movies No specific one Children programming

31% Religious programs I don’t have a TV Talk shows

46% Sports Documentaries Serials

Table 10.12: Lebanese respondents’ preferred type of TV programming Both female and male respondents in the Lebanese domain prefer to watch TV in the evening at 63% and 69%, or at night at 42% and 45% respectively. Mornings and afternoons are not as popular for watching TV, with percentages being slightly higher for female respondents than for male.

263

3%

42%

63%

18% 14% 12% 12%

Female

3%

45%

Male

10% 7% 9% No specific time

69%

15%

Night

Evening

Late afternoon

Early afternoon

Noon

Morning

Table 10.13: Lebanese respondents’ preferred time to watch TV during the day Access and use of the Internet Most Lebanese respondents of both genders access the Internet daily at 77% for female and 78% for male respondents. The percentage of respondents who never access the Internet is the same for women and men at 16%.

16% Female

1% 1% 5% 77% 16%

Male

1% 1%

5% 78% Never

A few times a month

Once a week

Every few days

Daily

Table 10.14: Lebanese respondents’ frequency of accessing internet Lebanese respondents use the Internet most to stay in touch with family and friends at 77%, to access social media at 71%, to receive information at 19% as well as to get news about Lebanon, the region and the world and for work between 14-16% respectively. Access and use of social media 77% of Lebanese respondents access social media, such as Facebook, Twitter and WhatsApp daily. 10% never access social media, 9% every few days. 83% of Lebanese use social media to stay in touch with family and friends, while 47% use it to get information on services. Preferred way of communication for services

264 58% of Lebanese respondents prefer to receive information about available UNICEF services via mobile phone and 43% by social media. However, A quarter of them would like to receive the information in person, through outreach volunteers.

2% 1% 4% 27% 13% 58% 43% Television Through posters Website on the Internet Social Media (incl. WhatsApp)

Through radio In person through outreach volunteer SMS/Mobile phone

Table 10.15: Lebanese respondents’ preferred way of receiving information about available UNICEF services

10.3.3. Syrians registered with UNHCR domain Preferred traditional media Among Syrians registered with UNHCR, the preferred medium of traditional media is television at 92%. Just one percent prefer radio or newspapers and 6% state not to like traditional media. Preferred type of TV programming 55% of female respondents in the registered Syrian domain prefer to watch serials on TV and 49% of male respondents in the same domain prefer to watch news. A few percent of both genders prefer children programming, and 6% of female respondents do not have a TV compared to 3% of male respondents.

265

Female

2% 6% 2% 9% 1%

55%

25%

Male

1% 2% 3% 3% 6% 1%

34%

Sports Documentaries Serials

No specific one Children programming News

49%

I don’t have a TV Talk shows

Table 10.16: Preferred type of TV programming of Syrian respondents registered with UNHCR Most registered Syrians prefer to watch TV in the evening and at night. Registered Syrian female respondents’ preferred time to watch TV is in the evening at 73% and male respondents’ in the evening at 81%. More female than male respondents prefer watching TV during the day, although are low overall.

2%

29%

Female

2% Male

73%

21% 16% 12% 16%

31% 8% 7%

No specific time

81%

16% 11% Night

Evening

Late afternoon

Early afternoon

Noon

Morning

Table 10.17: Preferred time to watch TV during the day of Syrians registered with UNHCR Access and use of the Internet 60% of male respondents in the registered Syrian domain access the Internet compared to 47% of female respondents. Critically, 49% of female and 38% of male respondents in the registered Syrian domain never access the Internet, representing a high proportion in contrast to Lebanese or Palestine refugee domains.

266

49% Female

3% 47%

38% Male

2% 60% Never

Every few days

Daily

Table 10.18: Frequency of accessing internet of Syrians registered with UNHCR 74% of registered Syrians use the Internet to access social media, 68% to stay in touch with friends and family. 15% use the internet to get information, which is a relatively low proportion. 16% use the Internet to get news about the region and the world. Access and use of social media 63% of registered Syrian respondents access social media on a daily basis, compared to 25% who state never to access social media. Around 10% access it every few days. In contrast to the Internet, registered Syrians use social media more to get information on services at 56%. 85% also use social media to stay in touch with family and friends and 22% to get news. Preferred way of communication for services While 75% of registered Syrians would like to receive information about available UNICEF services on their mobile phone, more than a third of respondents at 36% would prefer to receive this information in person through an outreach volunteer. Another 32% would prefer being contacted through social media.

1% 1% 3% 36% 4% 75% 32% Television Through posters Website on the Internet Social Media (incl. WhatsApp)

Through radio In person through outreach volunteer SMS/Mobile phone

Table 10.19: Syrians registered with UNHCR’s preferred way of receiving information about available UNICEF services

267

10.3.4. Syrian in ISs domain Preferred traditional media 86% of Syrians in ISs name television as their preferred traditional medium. At 86%, this majority is slightly smaller than in the other domains. 8% do not like traditional media and 5% do not prefer a specific one. This question covers attitudes, however in practice many ISs might not have access to TVs. Preferred type of TV programming In contrast to male respondents in the other domains, whose first preference is to watch news on TV, male respondents in the Syrian in ISs domain prefer to watch serials at 48% and female respondents at 50%. 32% of male and 24% of female respondents like to watch the news, followed by 9-10% of respondents who like to watch children’s programming.

1% 2%

12%

Female

10%

1%

50%

24%

Male

2% 2%

7% 9% 32%

Religious programs Documentaries Serials

No specific one Children programming News

48% I don’t have a TV Talk shows

Table 10.20: Syrians in ISs’ preferred type of TV programming While a majority of Syrians in ISs prefer to watch TV in the evening at 66% for female and 59% for male respondents, and around a third like to watch TV at night as well, many more Syrian in ISs respondents than in any of the other domains also watch TV throughout the day.

268

2%

31%

Female

16%

20%

66%

26% 27%

37% Male

22% 20% No specific time

Night

Evening

59%

41% 29%

Late afternoon

Early afternoon

Noon

Morning

Table 10.21: Syrians in ISs preferred time to watch TV during the day Access and use of the Internet 72% of female respondents in the Syrian in ISs domain never access the Internet, compared to 50% of male respondents. This stands in contrast to 43% of male and just 23% female Syrians in ISs who access the Internet daily.

72% Female

1% 1% 4% 23% 50%

Male 7% 43% Never

A few times a month

Once a week

Every few days

Daily

Table 10.22: Syrians in ISs frequency of accessing internet Syrians in ISs state to access the Internet the most to stay in touch with family and friends at 75%, to use social media at 42% and to get information in general at 15%. 11% use it to get news about the world and the region and 7% to get news about Lebanon. Access and use of social media 49% of Syrians in ISs access social media daily, in contrast to 33% who never access social media. 15% state to access social media every few days. When asked about what Syrians in ISs use social media for the most, 90% responded for staying in touch with friends and family and 38% to get new information on available services. 22% use social media to receive news about the region and world respectively and 20% to receive news about Lebanon.

269

Preferred way of communication for services Most Syrians in ISs at 53% prefer to receive information about available UNICEF services in person through an outreach volunteer, in contrast to 49% via mobile phone and 17% through social media. Qualitative data from FGDs with male and female Syrian caregivers confirms this, as they prefer to have person-to-person contact. This is mostly due to the fact that they often have specific questions and clarifications they like to ask.

1% 2%

53% 49% 17% Television In person through outreach volunteer Social Media (incl. WhatsApp)

Through posters SMS/Mobile phone

Table 10.23: Syrians in ISs preferred way of receiving information about available UNICEF services

10.3.5. Palestine refugees’ domain Preferred traditional media An overwhelming majority of respondents of Palestine refugees, at 94%, say that television is their preferred traditional medium. In comparison, newspapers are insignificant as traditional media at 1% and 4% do not like traditional media. Preferred type of TV programming Palestine refugees have the biggest gender difference on their preferred type of TV programming. While 70% of female Palestine refugees prefer to watch serials, 41% of male Palestine refugees prefer to watch the news. Over a third of male respondents does like to watch serials as well, while only 9% of female respondents like to watch the news.

270

2% Female

6% 9% 3%

70%

9% 1% 1% 1% Male

7% 4% 9%

37% 41%

Religious programs Documentaries Serials

Sports Children programming News

I don’t have a TV Talk shows

Table 10.24: Palestine refugees’ preferred type of TV programming Most respondents in the Palestinian domain state that they prefer watching TV in the evening, with 68% for female and 51% for male respondents. As in the Syrian in ISs domain, a large percentage of men and women like to watch TV during the day. After the evening, late afternoon scores highest at 32% for female and 40% for male respondents, unlike for all other domains where night is always the second-preferred option.

31% 68% 32%

Female

23% 21% 11% 28% 51% 40%

Male

22% 16% 19% Night

Evening

Late afternoon

Early afternoon

Noon

Morning

Table 10.25: Palestine refugees’ preferred time to watch TV during the day Access and use of the Internet 72% of female and 78% of male Palestine refugees access the Internet daily. A fifth of women at 20%, however, never accesses the Internet, compared to 12% of men. 91% of Palestine refugees use the Internet to access social media, the highest percentage of all domains. 65% use it to stay in touch with family and friends, while 27% use it to get information, also the highest percentage of all domains.

271

Female

1% 2% 4%

3% Male

20%

8%

Once a week

72%

12%

78% A few times a month

Every few days

Never

Daily

Table 10.26: Palestine refugees’ frequency of accessing internet Access and use of social media 77% of Palestine refugees access social media daily. 11% never access social media, while 7% access it every few days. 69% of Palestine refugees use social media to stay in touch with family and friends, 46% use it to get new information on services. In contrast, 30% use it to get news on the world, 26% on news about the region, which represent the highest percentages for these options across domains. Preferred way of communication for services 56% respondents in the Palestinian domain prefers to receive information about the available UNICEF services electronically through social media, 46% through mobile phones and 39% through a website on the Internet. However, 32% of Palestinian respondents would like to receive this information in person through outreach volunteers and 18% through posters.

2% 18% 32% 39% 46% 56% Through radio In person through outreach volunteer SMS/Mobile phone

Through posters Website on the Internet Social Media (incl. WhatsApp)

Table 10.27: Palestine refugees’ preferred way of receiving information about available UNICEF services

272

Bibliography Abla, Zeina and Muzna Al-Masri. 2014. Situation analysis of youth in Lebanon affected by the Syrian crisis. Beirut: UNFPA, UNICEF, Save the Children, and UNHCR. Internet World Stats. 2017. Lebanon Internet stats and telecommunications report. www.internetworldstats.com/me/lb.htm. Accessed 1 October 2017. IPSOS and Nielsen, 2017. Lebanon: 2016 TV audience measurement. https://www.ipsos.com/en/lebanon-2016-tv-audience-measurement Accessed 25 September 2017. Leffler, Abigail and Yee-Yin Yap. 2017. A communication analysis for UNICEF Lebanon. Malmö: Master thesis in Communication for Development, Malmö University. Northwestern University in Qatar. 2013. MENA Media Survey. www.scribd.com/embeds/148423818/content?start_page=3&view_mode=scroll&access_key=keyhhrnkzjb5s6ns9vu3md&show_recommendations=false. Accessed 1 October 2017. TNS. 2015. Arab Social Media Report. Dubai: Arab Social Media Influencers Summit. UNICEF. 2016. Lebanon Baseline Survey 2016. Beirut: UNICEF. UNICEF. 2017a. Communication for Development. www.unicef.org/cbsc/. Accessed 1 October 2017. UNICEF. 2017b. Communication for Development (C4D): The big picture. www.unicef.org/cbsc/index_42328.html. Accessed 1 October 2017.

273

11. BARRIERS AND RECOMMENDATIONS The analysis of data that were collected for the KAP Study identifies a range of knowledge gaps and attitudinal and practical challenges that act as barriers to health, education, WASH, child protection, child rights and social inclusion. KAP barriers can be overcome with social and behaviour change and an improved matching of supply and demand of services in terms of both volume and quality. Towards this end, the chapter concludes with a list of recommendations for further action.

11.1. Analysis Four overarching analytical categories emerged from the data that were collected for the KAP Study. They are best represented as binaries (pairs of opposites): • • • • •

Public/private Female/male Poor/not-poor Centre/periphery Emergency/development

The binary of public and private refers to the fact that public goods and services, on the one hand, and private interests, on the other, can be at variance. For example, public health might require a sufficient immunization coverage, while medical professionals, out of private interest, might discourage patients from using the vaccines available at public health centres (PHCs) and social development centres (SDCs) in order to convince patients to pay for privately provided vaccines, which, however, not everyone can afford. The female-male binary refers to the fact that gender relations are pervasive in almost all KAP Study data. To a considerable extent, men and women, as well as boys and girls, seem to lead different lives. Qualitative and quantitative data from the KAP Study show that knowledge, attitudes and practice tend to be gendered. (See the annex to this chapter for selected indicators disaggregated by gender.) The poor-not-poor binary, while a global Overarching analytical categories: phenomenon, is particularly consequential if paths - Sphere (public/private) out of poverty are largely unavailable. Official and - Gender (female/male) unofficial restrictions on who can hold what position of employment make it near impossible for - Income (poor/not-poor) certain groups in Lebanon to escape poverty. At the - Services (centre/periphery) same time, there exists an unregulated black labour - Response (emergency/development) market, which provides thousands of refugees with an opportunity to earn an income, though wages might be low, employment security might not exist and occupational safety and health protections might not be observed. The centre-periphery binary signifies regional asymmetries in Lebanon in terms of available services and opportunities, but also in terms of social norms, such as the just mentioned gender norms. Data collected for the KAP Study indicate that the presence of the Lebanese state and the role of civil society are rather limited in mohafaza like Akkar and Baalbek-Hermel. As far as policy decisions, available resources and services and employment opportunities are concerned, Beirut is the indisputable centre of Lebanon. The urban sprawl along Lebanon’s Mediterranean coast – a sprawl that also stretches inland – must be considered part of the socio-economic centre as well. In the periphery, resources, services and opportunities to earn an income are more limited and are often channelled through

274 networks of patronage. Residents of the periphery who are without or with very limited access to such networks, like Syrian refugees, are especially vulnerable. Others, like young men from Akkar, often enlist with the police and military and become teachers. Lebanon has taken in more international refugees per capita than any other country in the world. Most refugees in Lebanon arrived from Syria. It is estimated that the number of Syrian refugees in Lebanon might be as high as two million. Thus, the Syrian crisis created a situation that required an immediate and extensive humanitarian response. Resources, institutional capacities and services in Lebanon were overburdened. Strengthening Lebanon’s capacities to cope with the crisis have blurred the line between an emergency response and development. Regardless of such blurring, international organizations like UNICEF Lebanon realise that capacities need to be built. At the same time, there is resistance in Lebanon to hosting Syrian refugees in perpetuity and to create permanent structures and services for them.

GENDER The seemingly universal division of care and work between a public sphere that is largely male and a domestic sphere that is largely female, the discrepant social expectations placed on women and men, the transference of gender norms to a new generation, and so on, are indicative of a deeply gendered social order. -

-

-

-

Female caregivers are the primary decision-makers and agents with regard to children’s health, but often have to rely on financial support from their husbands and family. Men see to it that the household has water for drinking and general usage. Women are responsible for the hygiene of household members and the cleanliness of the home. Most respondents believe that girls and boys should participate equally in education. In practice, protection challenges, such as lack of documents, child labour, child marriage and safety concerns, prevent girls and boys from accessing education. The general perception among respondents is that there are more protection risks for girls than for boys. In cases of GBV and CP violations, both female and male respondents prefer to seek support from informal sources, like close family, rather than to turn to formal service providers. While caregivers perceive basic rights, like food, shelter and education, to be largely equal for girls and boys, rights of expression and self-determination are gendered. Due to traditional gender norms and perceived protection risks, the rights of expression and selfdetermination are more limited for girls. The care of children with disabilities tends to be the responsibility of mothers, who need to be proactive in seeking support and services.

Binaries are laden with values. The two concepts in the binary ‘poor-not poor’, for example, are not value-neutral. ‘Not poor’ is usually considered to have a more positive value than ‘poor’. Data from the KAP Study indicate that the binary ‘male-female’ is value-laden as well. Girls and young women are, for example, expected to know household skills before getting married, whereas boys and young men are supposed to be able to provide for a family before they can marry. Such expectations correspond to a division between domestic and non-domestic values. In similar fashion, the centreperiphery binary carries values that refer to the contrast between tradition and modernity, rurality and urbanity, social control and social anonymity, deprivation and prosperity, and so forth. The binary of emergency and development is laden with values related to agency and responsibility. Providing support in an emergency is likely to be seen as a humanitarian imperative, whereas development tends to raise more complex issues of who should act – or should have acted – and in what manner. Because resources are limited, the emergency-development binary is subject to value

275 judgements about what to prioritize. KII data indicate that the dilemma of allocating resources to either emergency relief or development is an ongoing topic of discussion within UNICEF as well. It is possible to apply one or more of the four overarching analytical categories to each barrier identified below. To do so opens up perspectives on the immensity of the challenges Lebanon faces.

11.2. Barriers and recommendations 11.2.1. Health Barrier • Among Lebanese and Syrian respondents there is limited awareness of available health services that are covered by the Government of Lebanon and the right to receiving such services. For example, right holders are not aware that MOPH even covers the greater part of the costs for child delivery at contracted private hospitals. Among Lebanese respondents there is a preference for private health services. Recommendations • The recommendation is to raise community awareness on health services by: - Communicating individuals’ right to health services - Communicating the improved quality of public health services - Spreading information on access points to health services - Strengthening community outreach actions Vaccination Barrier • Across all domains, a sizeable minority of respondents underestimated the number of vaccination sessions needed before a child’s first birthday for it to have received all recommended vaccines. Furthermore, quantitative data from the KAP Study indicate that few caregivers actually complete all of their children’s recommended vaccination sessions before their first birthday. Recommendations • A two-pronged supply-side approach is recommended: - An information campaign that specifically addresses the number of recommended vaccination sessions - A systematic follow-up programme organized and conducted by public health services that reminds caregivers to bring children to the next vaccination session. First-time and young mothers could be prioritized. Lessons learned from UNRWA’s follow-up approach might be relevant to design this programme. Barrier • Male respondents across domains are considerably less well informed about the health status of their children than female respondents. Some male respondents express clearly the view that women have sole responsibility for the care, including the health care, of their children. This places an extra burden on women and makes the provision of healthcare, including vaccinations, difficult because of perceived safety risks for women who are unaccompanied outside the home.

276 Recommendations • Two actions, based on the research team’s previous work with mixed-gender dialogue sessions,181 are recommended: - Develop a curriculum for mixed-gender parenting sessions, which includes a focus on gendered roles in caring for newborns and children. Participants in parenting sessions could be recruited in connection with antenatal care visits. A suggestion is to organize four parenting sessions of two hours each over the course of the pregnancy. - Recruit interested fathers-to-be as co-facilitators for continued organized dialogue groups among fathers. Barrier • A persistent rumour is that vaccines at PHCs are of inferior quality. This myth is perpetuated by some medical professionals with the intention of persuading patients to pay for vaccinations at privately-owned clinics instead of using the free or inexpensive vaccination service at PHCs and SDCs. Recommendations • Instead of targeting external stakeholders like caregivers, the recommended action targets internal stakeholders. Organize workshops for medical professionals on the relationship between medical ethics and business models in medicine. The initiative should be co-owned by UNICEF and MOPH and organized and conducted in collaboration with MOSA and Ordre des Médecins du Liban. A prioritized target group should be physicians working in public healthcare, especially physicians in PHCs and public hospitals. Breastfeeding Barrier • KAP Study data highlight widespread misunderstandings and myths on exclusive breastfeeding. Common practices include giving water with sugar or honey, camomile tea and other liquids or solids to newborns and infants. The relatively high percentage of respondents who favour exclusive breastfeeding contrasts with these practices, which seems to reveal a knowledge gap that is not filled adequately by medical professionals. Recommendations • Part of antenatal care must be to raise awareness on what constitutes exclusive breastfeeding, its evidence-based benefits and how to practice breastfeeding. KAP Study data show that the existing tool, the IYCF educational cards, used for this purpose, tend to promote a one-way communication model, largely due to time constraints. A participatory C4D model is recommended that encourages parents-to-be to come up with, and reflect on, solutions to challenges associated with exclusive breastfeeding. Barrier • While breastfeeding is recognized by MOPH to be the most beneficial method of feeding newborns and infants, this knowledge does not necessarily reach caregivers. KAP Study data indicate that formula is promoted excessively by healthcare services and that it, in some cases, even is provided to parents right after child delivery, before breastfeeding has been initiated. Qualitative data also point to a decrease in breastfeeding frequency in the Syrian domains, which appears to be linked to Syrian children being delivered in Lebanese hospitals. 181

Khattab 2016.

277 Recommendations • Like the recommendation for the vaccination barrier that is directed towards internal stakeholders, the recommendation for this barrier also targets internal stakeholders, in particular MOPH, MOSA and medical professionals. The recommendation is to organize workshops for medical professionals on the relationship between medical ethics and business models in medicine. The initiative should be co-owned by UNICEF and MOPH and organized and conducted in collaboration with MOSA and Ordre des Médecins du Liban. A prioritized target group should be physicians, nurses and midwives working in public healthcare, especially physicians in PHCs and public hospitals.

Households

MOSA

Children

Healthcare

MOPH

Caregivers

Medical professionals

Table 11.1: Internal and external stakeholders in healthcare (internal stakeholders: MOPH, MOSA and medical professionals; external stakeholders: households, children and caregivers).

11.2.2. WASH Water Barrier •

Access to clean drinking water and a sufficient supply of water for hygienic purposes is a challenge across domains but is most troublesome for already vulnerable groups like Syrian refugees living in ISs. Short-term solutions used during emergencies like delivering water by truck have become permanent services. The primary source of drinking water is bottled water, which is costly for individuals and households and, because of inadequate recycling, results in large quantities of plastic bottles that degrade the environment.

Recommendations •

Continued support in implementing projects at the water establishments and the Ministry of Energy and Water on the improvement of the quality and reach of piped water.

278

Sanitation Barrier •

Wastewater disposal presents a health and environmental challenge in all mohafazat and for everyone in Lebanon. Untreated or only slightly treated wastewater contaminates Lebanon’s soil, streams, groundwater and coastal waters. Syrian refugees living in ISs are often refused access to more sustainable solutions for wastewater disposal.

Recommendations •

Three initiatives are recommended: - Institutional capacity building to increase the use and efficiency of existing wastewater treatment facilities - Support the extension of wastewater networks, that are connected to treatment facilities, in accordance with Ministry of Energy and Water guidelines - Sponsoring of septic tanks for black water and filters for grey water in ISs - Community-based participatory C4D actions to raise awareness on the short- and long-term consequences of releasing unfiltered, untreated wastewater into the environment

Barrier •

KAP Study data show that, depending on domain, between 11 and 27% of respondents report that they dump solid waste randomly in the environment.

Recommendations •

Community-based participatory C4D actions with the double purpose of (a) organizing cleanup campaigns and (b) preventing that solid waste is dumped randomly in the environment

Hygiene Barrier •

In all domains, female respondents report that they abstain from showering and bathing during the first days of menstruation. Some even refrain from showering and bathing for the entire period. Various health risks were mentioned as resulting from showering or bathing during menstruation, such as ‘fibers’ [fibrosis], developing a sack of water in the uterus and that taking a shower can stop the period altogether.

Recommendations •

The recommendation is to conduct an awareness campaign that demystifies what menstruation is and debunks myths surrounding the period. The campaign could focus on appropriate hygiene practices during menstruation, as well as child protection issues like unwanted pregnancies after the onset of menstruation. Core messages could be adapted to the residential and living circumstances of the specific target group. For instance, social media content is likely to reach girls in the Lebanese domain but not necessarily girls in the Syrians in ISs domain.

279

11.2.3. Education Barrier •

KAP Study data indicate that there is a noticeable difference between domains when it comes to enrolment in formal education. While 93% of school-aged children in the Lebanese domain are enrolled in formal education, the number for children in the Syrians living in ISs domain is just 43%. For children in the registered Syrian domain, the figure is 63%. The quantitative and qualitative data show that there are a number of barriers to school enrolment: - A lack of teaching space; qualitative data indicate that when Syrian caregivers tried to enrol their children they were not admitted because of overcrowding in Lebanese public schools - Children not wanting to go to school; if collated with other quantitative and qualitative data from the KAP Study, possible reasons for children not wanting to go to school include teachers using verbal and physical violence against children and occurrences of bullying in school - Children dropping out of school to work; levels of child labour vary across mohafaza and domains. Most at risk are boys who are eager to assume adult responsibilities - Preventive costs of education, for example for transport, activities, stationary, and so on

Recommendations •

The recommendations consist of two types of action: - That resources are directed towards making more teaching space available. This would involve opening new schools or expanding the floor space of existing schools to meet the demand for basic education - It is recommended that the implementation of MEHE’s child protection policy, which was developed together with UNICEF, is intensified and is monitored more closely

Barrier •

According to qualitative KII data, caregivers in the Lebanese and Palestinian domains are often engaged in the school work of their children. In comparison, caregivers in the Syrian domains appear less involved and empowered. Possible reasons for the lower level of engagement include the educational background of the caregivers and language barriers related to the Lebanese curriculum.

Recommendations •

The recommendation is to support caregivers in the Syrian domains through (a) basic literacy and numeracy training and (b) accurate instruction on educational options. The purpose is for them to be more involved in their children’s school work and to help their children with their homework.

11.2.4. Child protection Barrier

280 •

While conservative norms already were widespread in Lebanon’s peripheral regions, KAP Study data suggest that they become even stricter and spread even wider. This trend includes an increasing frequency in child marriages, a strict separation of genders and, in the Syrian domains, forced pregnancies.

Recommendations •

The recommendation for this barrier is threefold: - To initiate a study on the root causes behind this barrier. Whether this is a transfer of social norms from Syria to Lebanon or the effect of negative coping mechanisms, or a mixture of both, or if it is caused by something else, needs further study. - Family planning sessions for couples in order to involve men and facilitate a dialogue between men and women. It is recommended that the sessions are organized in connection with postnatal care visits. - A participatory C4D action in the form of dialogue sessions for women and men separately. Sessions could potentially be conducted with mixed-nationality groups. The purpose of the dialogue sessions is to reflect on gender expectations and challenges and to change attitudes and behaviours. Sessions should be structured topically and designed differently for different age groups. It is suggested that dialogue groups run for at least six months.

Barrier •

Quantitative data from the KAP Study evince that only a minority of women would report to formal authorities if they had to tell someone about a GBV incident. For women in the Lebanese domain the number is 18%, for women in the registered Syrian domain it is 12%, for women in the Syrians in ISs domain it is just 8% and in the Palestinian domain it is 14%. While these percentages are not satisfactory, the data also make clear that a majority of women in all domains would report GBV incidents to their husband or other family and community members.

Recommendations •

The recommendation consists of three parts: - Continue to build capacities of formal authorities to act appropriately and efficiently in response to reported cases of GBV and CP incidents. - Create greater awareness about available formal CP and GBV services. - Develop community-based solutions for GBV prevention and CP, for example by starting up pilot projects in Akkar and Bekaa that involve community leaders.

Barrier •

The vast majority of respondents in all domains does not know that, by law, the maximum number of working hours per day for children is 6 hours. Most respondents think that children are allowed to work more hours per day.

Recommendations •

The recommendation is to strengthen the capacity of labour law enforcement, in particular with regard to labour inspections.

281

Barrier •

A majority of respondents (74-86%) in all domains think that positive discipline is useful. At the same time, 35% of respondents in the Lebanese domain find shouting at a child useful, as do 35% of respondents in the Palestine refugee domain. In the registered Syrian domain, the number is 33% and in the Syrians in ISs domain it is 43%. In the Lebanese domain, 21% of respondents find it useful to spank, hit or slap the child on the bottom. For Syrians registered with UNHCR this number is 22%, for Syrians in ISs it is 30% and for Palestine refugee respondents it is 32%. These figures suggest that there is a gap between favourable attitudes towards positive discipline and disciplining practices.

Recommendations •

The recommendation consists of two parts: - Further study to investigate the reasons behind the gap between favourable attitudes towards positive discipline and disciplining practices - C4D efforts directed to caregivers should present concrete examples of and practical tools for positive disciplining methods, along with promoting the respect for the bodily and intellectual integrity of children. Such efforts bridge the priority areas of CP and CR because the issue of children’s integrity is common to both.

11.2.5. Child rights Barrier • Awareness of child rights is widespread. Even children know, for example, that they are not supposed to work or marry very young. This knowledge is limited, however. Respondents believe that child rights refer to basics like food, clothes, education and so on, but not to children’s right of expression, participation, inclusion and decision making. This points to an awareness gap between considering children to be entitled to care and seeing children as persons with a right to dignity, integrity and self-expression. Recommendations • It is recommended that a focus on children’s personhood, capacity of self-expression and agency in decision-making informs UNICEF Lebanon’s programmes. This means, for example, that programming that targets children should be participatory already at the design stage. Children could be involved in the planning and implementation of programme activities. This would provide children with an opportunity to ‘exercise their voice’ and articulate their aspirations.

11.2.6. Disability Barrier •

Disability is the programmatic area that is in greatest need of C4D action, starting with capacity building in the field of professionally identifying disabilities. An overwhelming majority of respondents in all domains are unaware of the right to social inclusion for children with disabilities. Prejudices and lack of knowledge abound in the field of disability. Despite people

282 with disabilities being among the groups most at risk of exclusion and exposure to violence, they are rarely acknowledged and targeted in programming. Recommendations • Two recommendations address this barrier: - Capacity-building C4D interventions targeting internal stakeholders like UNICEF staff, ministries and partners. The objective is to fill conceptual and practical knowledge gaps, with a focus on helping stakeholders integrate a disability perspective into their programmes. Different programme areas require different approaches to meet this objective. - The scale of the barrier demands a nation-wide awareness campaign for external stakeholders. Such a campaign should communicate the capacity of children with physical and intellectual disabilities and provide positive examples of individuals with disabilities who are socially integrated.

Barrier • KAP Study data indicate that there is widespread confusion about the difference between, on the one hand, physical and intellectual disabilities and, on the other hand, physical and mental illnesses. Recommendations • Part of the nation-wide awareness campaign mentioned in the above recommendation should be to explain in a single phrase the difference between disability and illness.

Barrier • There is more willingness to socially include anyone with physical disability than there is to include persons with intellectual disability. The reasons provided by respondents for this difference is that they fear that people with intellectual disabilities might become violent. Recommendations • The recommendation is to conduct community outreach actions that create opportunities for personal interaction between community members with and without disabilities. The express purpose is to open a path to social integration in the community.

11.2.7. C4D Barrier •

Nearly half of female respondents in the registered Syrian domain never access the Internet. For male respondents, the corresponding number is 38%. Almost three quarters of female respondents in the Syrian in ISs domain never access the Internet, nor do half of male respondents. 43% of male and just 23% female Syrians in ISs access the Internet daily. While most Palestinians access the Internet daily, a fifth of women never accesses the Internet. C4D actions that make use of the Internet are therefore unlikely to reach the most vulnerable groups.

Recommendations •

A majority of Syrians in ISs prefer to receive information about available UNICEF services in person. Qualitative data from FGDs with Syrian women confirm this.

283 The fact that considerable percentages of respondents in all domains do not access the Internet and that there is a demand for face-to-face communication should inform all of UNICEF Lebanon’s communication efforts towards external stakeholders.

Bibliography Khattab, Lana. 2016. Séances mixtes en couples – Femmes petites commerçantes transfrontalières congolaises et leurs époux. Goma: International Alert.

284

Annex: Selected indicators disaggregated by gender Health

% of respondents who know that children need to be brought to the health facility at least 6 times to complete the recommended vaccines by the child’s first birthday % of respondents who believe in exclusive breastfeeding

% of respondents who believe it is important to breastfeed until 24 months

Lebanese residents




Male

61%

52%

57%

49%

Female

73%

59%

55%

38%

Total

69%

55%

55%

42%

Male

95%

94%

95%

95%

Female

96%

97%

99%

99%

Total

95%

96%

99%

97%

Male

41%

63%

79%

59%

Female

46%

65%

86%

48%

Total

44%

64%

85%

53%

Total

64%

96%

50%

Table 11.2: Health indicators by domain and gender

Water, sanitation and hygiene (WASH) Water Lebanese residents Three main sources of drinking water for

Male

Female

Total

Piped water supply

34%

32%

33%

Bottled water

52%

55%

54%

285 household members


7%

8%

8%

Male

Female

Total

Piped water supply

30%

30%

30%

Bottled water

48%

48%

48%


12%

11%

12%

Male

Female

Total

Tanker-trucking

43%

46%

43%

Bottled water

27%

21%

22%


14%

15%

15%


Male

Female

Total

Piped water supply

36%

19%

27%

Bottled water

40%

75%

60%

Rain water

21%

3%

11%

Syrians registered with UNHCR Three main sources of drinking water for household members Syrians living in ISs Three main sources of drinking water for household members

Three main sources of drinking water for household members

Table 11.3: Drinking water indicator by domain and gender Hygiene For a detailed gender breakdown of responses, see tables 5.12, 5.13, 5.17, 5.18, 5.22, 5.13, 5.29 and 5.30.

Education

% of caregivers who know how to enrol children in formal school % of caregivers who are aware of nonformal education activities and programmes

Lebanese residents




Male

66%

54%

43%

93%

Female

67%

61%

36%

90%

Total

67%

57%

37%

91%

Male

NA

4%

0%

26%

Female

NA

7%

7%

27%

Total

NA

6%

6%

27%

Totals

67%

6%

286

% of caregivers who believe girls should be in school until they graduate

Male

96%

86%

86%

79%

Female

97%

89%

81%

77%

Total

96%

88%

82%

78%

% of caregivers who would never enrol their children in public or UNRWA schools

Male

47%

26%

39%

21%

Female

50%

28%

48%

8%

Total

49%

27%

46%

14%

Boys

93%

62%

45%

83%

Girls

94%

64%

42%

92%

Total

93%

63%

43%

87%

83%

Total

% of children who are enrolled in formal education

93%

43%

Table 11.4: Education indicators by domain and gender

Child protection

% of respondents who believe that marriage under 18 years of age has negative consequences and could name at least one negative consequence % of respondents who believe that a woman would report to formal authorities if she had to tell someone about a GBV incident % of respondents who would report to formal authorities in case they had to tell someone about a case of CP

Lebanese residents




Male

75%

63%

48%

50%

Female

77%

66%

62%

71%

Total

76%

64%

60%

62%

Male

24%

18%

9%

13%

Female

31%

19%

16%

24%

Total

28%

19%

14%

20%

Male

34%

20%

16%

17%

Female

37%

24%

14%

32%

Total

36%

22%

14%

25%

73%

17%

21%

287 % of respondents who believe that protection services provided to children and women through MOSA and NGOs are helpful % of respondents who answer that children’s participation in armed violence is not justified under any circumstances % of respondents who know that the minimum working age in Lebanon is from 18 years and older % of total respondents who know that the maximum number of working hours per day for children by law is 6 hours % of respondents who know that it is wrong to hit children

% of respondents who exhibit positive attitudes towards positive discipline methods

Male

50%

40%

32%

51%

Female

51%

38%

52%

62%

Total

50%

40%

42%

56%

Male

93%

94%

95%

83%

Female

93%

90%

95%

91%

Total

93%

93%

95%

87%

Male

85%

79%

80%

81%

Female

87%

69%

57%

72%

Total

86%

75%

61%

76%

Male

4%

3%

2%

4%

Female

5%

4%

13%

5%

Total

5%

4%

11%

5%

Male

72%

75%

73%

70%

Female

69%

73%

62%

66%

Total

70%

74%

63%

68%

Male

84%

86%

74%

73%

Female

86%

87%

83%

73%

Total

85%

86%

82%

73%

84%



Total

49%

93%

83%

5%

71%

Table 11.5: Child protection indicators by domain and gender Child rights

Lebanese residents


288

% of respondents who are aware of child rights

% of duty bearers who have positive attitudes towards preventing child rights violations

Male

89%

91%

77%

73%

Female

92%

92%

76%

88%

Total

91%

91%

76%

81%

Male

95%

94%

95%

99%

Female

95%

93%

94%

93%

Total

95%

94%

94%

96%

84%

81%

87%

90%

87%

76%

88%

73%

86%

79%

88%

81%

South Nabatieh

% of caregivers Male who believe that children need to be Female listened to in matters affecting Total them

% of Lebanese households who are aware of the NPTP

Beirut

Mount Lebanon

North and Akkar

Male

38%

31%

25%

34%

Female

20%

22%

28%

Total

27%

26%

27%

90%

95%

84%


Total

21%

31%

31%

39%

11%

25%

25%

37%

15%

26%

27%

Table 11.6: Child rights indicators by domain and gender

Disabilities Lebanese residents




Totals

EDUCATION % of respondents who believe children with physical disabilities should go to regular preschools and schools.

Male

55%

45%

57%

41%

Female

55%

46%

48%

61%

Total

55%

45%

49%

52%

% of respondents who believe children with

Male

16%

16%

11%

21%

Female

19%

18%

10%

25%

53%

289 intellectual disabilities should go to regular preschools and schools.

Total

WORK % of respondents Male believe that young people with Female physical disabilities should Total work % of respondents Male believe that young people with Female intellectual disabilities should Total work SOCIAL LIFE % of respondents Male who believe children with Female physical disabilities should be integrated into Total society % of respondents Male who believe children with Female intellectual disabilities should be integrated into Total society COMMUNITY LIFE % of respondents Male who believe that children with Female physical disabilities should participate in Total community life % respondents Male who believe that children with Female intellectual disabilities should Total participate in community life RESIDENTIAL INSTITUTIONS

18%

17%

11%

23%

70%

35%

39%

49%

65%

31%

32%

60%

67%

33%

33%

55%

20%

10%

7%

12%

22%

9%

5%

13%

21%

9%

6%

12%

73%

59%

52%

40%

69%

53%

47%

51%

70%

56%

48%

46%

22%

31%

27%

20%

27%

36%

14%

19%

25%

34%

16%

20%

70%

55%

54%

51%

66%

50%

50%

62%

68%

53%

51%

58%

23%

33%

27%

37%

27%

38%

14%

37%

25%

31%

16%

37%

18%

59%

18%

66%

26%

64%

27%

290 % of respondents Male 61% 60% who find it acceptable if Female 59% 56% families of children with physical disabilities place Total 60% 58% them in residential institutions % of respondents Male 61% 72% who find it acceptable if families of Female 62% 66% children with intellectual disabilities place Total 61% 70% them in residential institutions Table 11.7: Disabilities indicators by domain and gender

57%

69%

46%

63%

48%

66%

72%

73%

77%

74%

76%

73%

60%

64%

C4D Preferred type of TV programming

Serials

News

Male respondents

Female respondents

Total

Lebanese residents

31%

62%

50%


34%

55%

45%


48%

50%

50%


37%

70%

56%

Total

32%

61%

49%

Lebanese residents

46%

19%

29%


49%

25%

38%


32%

24%

26%

291

Documentaries

Children programming

Talk shows

No TV


41%

9%

23%

Total

46%

19%

30%

Lebanese residents

10%

7%

8%


3%

2%

3%


2%

0%

1%


1%

2%

1%

Total

8%

6%

7%

Lebanese residents

1%

4%

3%


6%

9%

7%


9%

10%

10%


4%

9%

7%

Total

3%

6%

4%

Lebanese residents

5%

5%

5%


1%

1%

1%


2%

1%

1%


9%

3%

6%

Total

5%

4%

4%

Lebanese residents

1%

1%

1%


3%

6%

4%


7%

12%

11%

292 Palestine refugees living in camps

1%

2%

1%

Total

2%

2%

2%

Table 11.8: C4D indicators by domain and gender Lebanese Syrians residents registered with UNHCR

Syrians Palestine living in ISs refugees in camps

Total

% of respondents who access the internet daily

Male

78%

60%

43%

78%

73%

Female

77%

47%

23%

72%

69%

Total

77%

54%

26%

75%

71%

% of respondents who never access the internet

Male

16%

38%

50%

12%

21%

Female

16%

50%

72%

20%

24%

Total

16%

43%

68%

16%

23%


Total

Lebanese residents % of respondents who access the social media daily % of respondents who never access social media



Male

79%

64%

60%

81%

76%

Female

76%

61%

46%

74%

74%

Total

77%

63%

49%

77%

75%

Male

9%

23%

32%

4%

11%

Female

10%

28%

33%

10%

12%

Total

10%

25%

33%

7%

12%

Table 11.9: C4D indicators by domain and gender Preferred way of communication about available UNICEF services (multiple choice) Male respondents Female respondents Mobile phone (SMS)

Total

Lebanese residents

61%

55%

58%


75%

75%

75%


41%

51%

49%

293

Social media

In person (through outreach volunteer)


45%

47%

46%

Total

32%

61%

49%

Lebanese residents

44%

43%

43%


34%

29%

32%


23%

16%

17%


63%

50%

57%

Total

32%

61%

49%

Lebanese residents

24%

26%

23%


36%

35%

36%


49%

54%

53%


34%

31%

32%

Total

32%

61%

49%

Table 11.10: C4D indicators by domain and gender